Reflective Journal on Cultural Competence for Indigenous People

This reflective journal discusses the importance of cultural competence for nursing professionals while treating Indigenous people. It uses the 4-R framework to reflect on the learning throughout the course and how it would be applied to future practices.

Running head: REFLECTION JOURNAL B
REFLECTION JOURNAL B
Name of the student:
Name of the university:
Author note:

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Introduction:
It is the duty of nursing professionals to engage with patients as individuals in a culturally
safe as well as respectful manner. This is associated with fostering open and honest professional
relationships and adhering to the different obligations about privacy and confidentiality (Gwynne
& Lincoln, 2017). Nurses need to develop cultural competency skills to provide respectful and
high quality care to Indigenous people. This assignment would be a reflective piece that would
be using the 4-R framework to reflect on the learning throughout the course and how it would be
applied to future practices.
Reporting:
Throughout the courses, I got an excellent opportunity to develop a detailed idea about
the concept of cultural competence and the ways it needs to be practices in the real-life scenarios
while treating Indigenous people. The detailed discussion carried by our mentor helped us
develop idea about the health gap that exists between Indigenous people and non-Indigenous
people. The mentors discussed various factors that contributed to the health gap. I was quite
surprised to see that racism, discrimination, and stigmatization were some of the governing
factors that prevent Indigenous people from getting services from the western healthcare system.
Initially, I was culturally biased and I used to think that they do not take care of their health
because they are reluctant and careless about their lives. However, the lectures made me realize
that cultural incompetency by the healthcare professionals in their practices as well as racism and
stigmatized behaviors are other factors that prevent Indigenous people from getting services.
Inaccessibility to healthcare services have been noted as one of the most crucial social
determinants of health associated with poor quality health and presence of health gap between

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the two cohorts (Power et al., 2016). Cultural incompetency is one factor that leads to such
inaccessible health services for Indigenous people and hence, I have developed the knowledge
that I have to develop cultural competency in ways by which I can provide healthcare services to
Indigenous people that would align with their expectations and make them feel respected.
Relating:
During the time of placement, I got the opportunity to work with experienced seniors. I
remember of one such incident where I felt that the Indigenous service user who came to seek for
the service had not been attended or treated respectfully. At that time, the senior nurse was
entirely unaware about the cultural conditions of the Indigenous people and the ways Indigenous
people need to be communicated with. I felt that the nurse was culturally biased and exhibited
judgmental behavior. One of the sentence she used was “I do not understand why all the
aboriginals are alcoholic….you need to know that tobacco use and alcohol consumption are
injurious to health”. This statement was not only insensitive but generalized all Indigenous
people as alcoholic, which affected the self-esteem of the Indigenous patient. After attending the
class lectures, I developed great amount of knowledge, which now helped me to identify the
mistakes that were made by the nursing professional while treating Indigenous people. Every
nursing professionals need to develop cultural awareness and cultural knowledge about the
cultural inhibitions, preferences, traditions, customs and communication style of the Indigenous
people in order to provide quality care to the patients that satisfies them. Indigenous people have
specific communication mannerisms, which are quite different from western healthcare systems.
They do not prefer eye contact as this is considered disrespectful for them (Bennett et al., 2018).
Moreover, they are not comfortable by touch and similar gestures from strangers unlike that of
the western people. It is also seen that they prefer long periods of silence during communication,

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which are not liked by western people who try to fill such gaps immediately (Biles, 2018). The
senior nursing professional was not aware of such cultural traditions of their communication
methods. These made the patient feel disrespected. I believe that i have the cultural knowledge
and awareness of attending needs of Indigenous people successfully. However, I fear that I might
be also culturally biased and hence I would need to undertake practices that are more reflective.
This would help me to recognize out my weak point effectively.
Reasoning:
Although, the lectures and the topics taught on exhibiting cultural competence for
Indigenous people helped me develop a good amount of knowledge about their traditions, their
history, their expectations and the ways to manage their needs, I feel that the cultural biasness
that I possess for them might create barriers in my practice. I might pass on disrespectful or
judgmental comments involuntarily that might affect the dignity of Indigenous patients who
come to seek for care services. In order to overcome my cultural biasness and develop my skills
of cultural competence, I would need to undertake rigorous reflective practices to realize the
domains where I need changes in my attributes and soft skills. However, I do believe that if I
follow the NMBA standards for cultural competency, I would be benefited in providing
culturally competent care for Indigenous people. The codes of conduct under principle 3 advises
nursing professionals about providing utmost respect to Indigenous people and providing them
holistic care that prove to be culturally safe for them. Ensuring respecting the diversity of the
culture of the Indigenous people and their “whole of life” views as well as need for holistic care
(principle 3.1), providing culturally safe and respectful practices (principle 3.2) and culturally
competent communication (3.3) would help nurses to ensure patient satisfaction among the
Indigenous communities. West et al. (2018) is of the opinion that when nurses respect cultural

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preferences, inhibitions, and traditions of the Indigenous people through exhibition of cultural
competency by the nurses, the patient satisfaction increases. The Indigenous people feel that
their dignity and autonomy are respected and that they are not stigmatized or discriminated by
western healthcare services. This would inevitably result in better patient experiences, which
would increase their trust, and dependency on the healthcare services (Usher et al., 2017). In
course of time, through culturally safe and competent care, the healthcare accessibility issues
faced by Indigenous people could be addressed. This would help in meeting the larger goal of
overcoming the health-gap issue to considerable extent.
Reconstruction:
It has been found by me though successive reflective practices that I need to overcome
cultural biasness that I have for Indigenous people, which might get pronounced while caring for
them. Hence, I would first need to work over my self-awareness and self-regulation skills
development to ensure that I overcome such beliefs and do not allow them to affect my thinking
and work practices. For that, I would be discussing the issues with my mentor and work as per
his guidelines and advices. I would also join mindfulness based therapies and others. Glover
(2017) opines that mindfulness based therapies, yoga, and medication and similar others might
help me develop self-regulation and self-awareness skill. This would prevent me from making
judgmental comments and showing disrespectful behaviors. Moreover, I also need to be “aware
of self” for which, I would note down my thoughts and reflect my practices in reflective journals
to find out how well I am overcoming such biasness. I would interview Indigenous healthcare
professionals. They can help me to develop more knowledge about the barriers that I might face.
They can also tell me the ways to overcome them. I would also undertake evidence based
searches to keep my knowledge up-to-date and provide proper care to Indigenous people that

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align with their cultural preferences and make them feel that their dignity and autonomy are
respected.

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References:
Bennett, B., Coghlan, C., Evans, K., & Morse, C. (2018). Incorporating aboriginal and Torres
strait islander curriculum frameworks into practice and implications for
employment. Journal of Australian Political Economy, The, (82), 171.
Biles, J. (2018). The development of Indigenous Australian cultural competence in
nursing. Australian Nursing and Midwifery Journal, 26(4), 40.
Glover, R. (2017). Aboriginal and Torres strait islander patients and their family's experience
when engaging in discharge. Communities, Children and Families Australia, 11(2), 15.
Gwynne, K., & Lincoln, M. (2017). Developing the rural health workforce to improve Australian
Aboriginal and Torres Strait Islander health outcomes: a systematic review. Australian
Health Review, 41(2), 234-238.
Power, T., Virdun, C., Sherwood, J., Parker, N., Van Balen, J., Gray, J., & Jackson, D. (2016).
REM: A collaborative framework for building indigenous cultural competence. Journal
of Transcultural Nursing, 27(5), 439-446.
Usher, K., Mills, J., West, R., & Power, T. (2017). Cultural safety in nursing and
midwifery. Contexts of Nursing: An Introduction, 337-350.
West, R., Mills, K., Rowland, D., & Creedy, D. K. (2018). Validation of the first peoples cultural
capability measurement tool with undergraduate health students: A descriptive cohort
study. Nurse education today, 64, 166-171.

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