Cultural Safety Issues in Erica's Appendix Case

This article discusses the cultural safety issues faced by Erica in her appendix case. It highlights the ineffective communication, cultural discrimination, disrespect, and discharge without medical advice. The impact of these issues on Erica's treatment process is also explored.

iSAPCase: Erica’sAppendix (Post-opDay 1)
Thefollowingtablehas space for fourevents (oneofthembeingherdischargeagainstmedicaladvice). Please note that there are more
than four events that you can choose from so please ensure that you choose those most relevant for cultural safety.
Event 1 Event 2 Event 3 Final event
Event Ineffective communication
and poor therapeutic
engagement with the patient
Ercia
This is clearly evident from
the information provided by
the case scenario which states
that Erica had not engaged
with Robyn in the
communication process
during her hospital stay. Also,
Robyn mentions the same to
the nurse working in the same
shift and assumes that Erica is
keen to be discharged and
does not like staying in the
hospital.
Cultural discrimination and
poor cultural competence
displayed by RN Robyn.
RN Robyn while taking
care of Erica and
introducing herself, casually
mentions by looking at the
case report ‘I notice it says
on your chart that you are
Aboriginal. Gosh, you don’t
look Aboriginal”. The
sentence spoken clearly
reflects a prejudiced and
judgmental tone and
critically triggers cultural
discrimination. Further,
when Erica mentions that
she wishes to leave soon so
that she can take care of her
ill mother, RN Robyn
casually mentions, ““You
need to get yourself better
before you can go home
because you will be no use
Disrespect shown to patient
“The patient was not educated
about her health condition
before the surgery. Also, the
racial comments of the RN
Robyn reflected feelings of
cultural discrimination. This
suggests that the patient had
been disrespected. Also, while
communicating with the
patient, the nurse talks
uninterruptedly and does not
ensure whether or not Erica is
comfortable in her presence.
Clearly, the nurse did not
belong to the similar cultural
background as that of Erica and
did not care to address her
culture specific needs. This also
suggests that Erica was
disrespected.
Discharged without medical
advice.
By the end of the treatment
process, Erica had become
anxious and had become
extremely frustrated with the
treatment process. This can be
mentioned as the reason, why
Erica left without notice or
waited for a proper discharge
planning and medical advice.

to anyone. Let’s wait and
see what the surgeon says.”
This further reflects another
prejudiced statement that
evokes discrimination.
Related
safety risk
The related safety in relation
to ineffective communication
and creation of a positive
therapeutic relationship can
be mentioned as lack of trust
and confidence of the patient
in the treatment process.
According to Adams (2014),
effective communication and
positive rapport helps in
building patient trust in the
treatment care process.
Further, effective
communication helps in
clearly identifying patient’s
care priorities and facilitates
active engagement of the
patient in the care process
(Australian Indigenous Health
InfoNet, 2015). In this case,
RN Robyn should have taken
note of Erica’s response and
modified her communication
style. The nurse should have
shown empathy as Erica just
had her surgery and should
have ensured that she is
The related safety concern
can be identified as cultural
discrimination and lack of
cultural competence. As
suggested by Australian
Commission on Safety and
Quality in Health Care (2017),
cultural competence forms an
essential aspect of the NMBA
guideline which expects
nursing professionals to
deliver care in a culturally safe
and effective manner. In this
case, the causal comments
made by RN Robyn reflected
cultural incompetence and
discrimination. This can be
accounted for the cause why
Erica left the hospital without
a discharge medical plan. As
suggested by Harding (2013),
care professionals often
discriminate patients
belonging to the indigenous
and aboriginal background.
This results in increased
dissatisfaction and reduces
The NMBA professional code of
conduct for the nurses under
the standard 2, action 2.2
expects registered nurse to
treat the patients with dignity
and value their cultural belief
and rights so as to engage in a
positive therapeutic
relationship
(Nursingmidwiferyboard.gov.au,
2019M). It further expects
nurses to believe that patients
are the experts of their life
experiences and make use of
appropriate delegation,
coordination, supervision,
consultation and referral in
order to achieve positive health
outcome for the patients (Pauly
et al., 2014). The RN is
expected to provide
information and educate the
patient so as to enhance their
control over the health issue. In
this case, RN Robyn did not
educate the patient about her
health condition before or after
Before discharging a patient, it
is important to conduct a
discharge medical planning and
arrange a follow-up session
(Nursingmidwiferyboard.gov.au,
2019). In this case, Erica had not
been consulted even once in
the decision making process for
the application of the treatment
interventions. Also, Erica’s
queries in relation to her
discharge was responded coldly
by RN Robyn. Therefore, RN
Robyn should have considered
the patient needs and
accordingly devised a discharge
plan by partnering with the
patient in the care process. This
would have helped in the
completion of care process and
would have promoted positive
recovery of the patient.

comfortable. Further, the
nurse should have maintained
an open communication style
and ensured that Erica is able
to actively participate in the
conversation and convey her
problems.
their accessibility to avail
healthcare services
(Antonsen, 2017). RN Robyn
should have asked Erica about
her culture specific
requirement and then went
ahead with her treatment
process. In order to provide a
culturally effective care, RN
Robyn could have arranged a
referral to an aboriginal nurse,
so as to make Erica
comfortable with her care
process. Upon engaging an
aboriginal nurse, Erica would
have been able to express and
share her concerns in a better
manner and her recovery
process would have been
effective (Pauly et al., 2015;
Strobel et al., 2014).
the surgery. Also, she did not
adapt any measures such as
referral to a psychologist to
ensure that Erica is able to deal
with the stress post her
operation. Also, during the
treatment process, RN Robyn
did not involve Erica in the
decision making process and
also made racial comments
which further suggests a
compromise of the patient’s
respect and dignity. RN Robyn
could have imparted health
literacy to the patient so as to
make her aware about the
health related condition and
involved her in the decision
making process so as to show
respect to the patient’s choices
and render effective care.
References:
Adams, K. (Ed.) (2014). Koorified: Aboriginal communication and well-being. Retrieved from
http://www.vaccho.org.au/vcwp/wp-content/uploads/2011/03/Koorified-Aboriginal-Communication-and-Well_Being.pdf
Antonsen, S. (2017). Safety culture: theory, method and improvement. CRC Press. DOI: https://doi.org/10.1201/9781315607498
Australian Commission on Safety and Quality in Health Care. (2017). National Safety and Quality Health Service Standards: User Guide for Aboriginal and
Torres Strait Islander Health. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-
Health-Service-Standards-User-Guide-for-Aboriginal-and-Torres-Strait-Islander-Health.pdf

Australian Indigenous Health InfoNet. (2015). [website]. Retrieved from http://www.healthinfonet.ecu.edu.au/
Harding, T. (2013). Cultural safety: a vital element for nursing ethics. Nursing Praxis in New Zealand, 29(1). Retrieved from:
https://books.google.co.in/books?hl=en&lr=&id=vzzdCwAAQBAJ&oi=fnd&pg=PP1&dq=cultural+safety+nursing&ots=mNuk2nwumt&sig=-
0Dbcua6FHrDHcseDITJvcnqhsk#v=onepage&q=cultural%20safety%20nursing&f=false
Nursingmidwiferyboard.gov.au (2019). Nursing and Midwifery Board of Australia - Professional standards. [online] Nursingmidwiferyboard.gov.au. Available
at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 16 May 2019].
Pauly, B. B., McCall, J., Browne, A. J., Parker, J., & Mollison, A. (2015). Toward cultural safety. Advances in Nursing Science, 38(2), 121-135. DOI:
https://doi.org/10.1097/ANS.0000000000000070
Strobel, N., McAulay, D., Sim, M., Hayward, C., & Rudd, C. (2014). Communicating with Aboriginal and Torres Strait Islander peoples. In T. Levett-Jones & B.
Baraclough (Eds.), Critical conversations for patient safety: an essential guide for health professionals. Australia: Pearson. Retrieved from:
https://pearson.com.au/products/K-L-Levett-Jones-Tracy/Critical-Conversations-for-Patient-Safety-An-Essential-Guide-for-Health-Professionals/
9781486004270?R=9781486004270