Critical Reflection: Patient-Centered Care in Healthcare Practice

This essay provides a critical reflection on the importance of patient-centered and culturally safe care in nursing practice. The author, a student nurse, recounts an experience with an Aboriginal patient, highlighting the challenges of providing care, particularly due to cultural barriers and the patient's past experiences with discrimination. The essay discusses the health issues faced by Aboriginal Australians, including cardiovascular diseases, and the impact of cultural factors on healthcare delivery. It emphasizes the importance of professional responsibilities, including building patient-nurse relationships and practicing cultural safety through cultural knowledge and competence. The author outlines plans to improve future practice, ensuring culturally safe and patient-centered care to improve health outcomes for all patients, particularly Aboriginal and Torres Strait Islander people.

Running head: CRITICAL REFLECTION 1
Patient-Centered and Culturally Safe Care
Name
Institution

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Critical Reflection
Introduction
Thesis statement: providing a patient-centred and culturally safe care is a fundamental part of the
practice of nursing that helps in ensuring quality and improved health outcomes. A patient-
centred approach to care ensures that the specific health needs and the health outcomes that are
desired by an individual form the basis of all the healthcare decisions to ensure quality and safe
health outcomes. This approach sees patients as partners with the healthcare practitioners thus
ensuring that the practitioners offer care that is not only clinically appropriate but also
emotionally, socially, spiritually, mentally, and financially appropriate. The missions and values
of this type of care are aligned with the goals of the patient. Additionally, the patient’s family are
included in the care plan to improve health outcomes. It is also important to note that patient-
centred care must be culturally safe to improve patient experience and improve health outcomes.
Cultural safety empowers both the patient and the healthcare practitioner and the idea of
culturally safe care was established because of the poor health status of the aboriginal
Australians. The values and beliefs of an individual are assessed and the potential they have on
people identified. In this paper, I will talk about a client I met during my practice as a student
nurse and the health issues faced by the client. I will additionally use the codes and standards of
nursing practice in addition to the knowledge gained throughout the course to reflect on my
future practice. Furthermore, I will discuss the impact of cultural factors in my future practice in
the provision of health care that is culturally safe to the Aboriginal and Torres Islander people.

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Selected Client
A year ago while working in a public hospital in Adelaide, I met a 30-year-old male patient from
the aboriginal community. His name was Lewis; a very interesting and outgoing man. He
presented at the hospital with a heart attack. He had been rushed to the hospital by his young
brother and he was unresponsive. I was happy to receive him and offer him the best care to
ensure that he had a safe and quality health outcome. It was a good experience to witness the
smile and happiness on his face due to the care that I provided. We managed to create a good
patient-nurse relationship that allowed him to confide and have trust in me. I made sure that he
was part of the decision-making regarding the procedures and medications that were proposed
for his recovery.
I must, however, accept that the experience came with a lot of challenges that I may not have
expected when I started. Firstly, I was still just a student nurse and massively inexperienced at
this level. I did not know how to handle patients appropriately but these are things that get better
with time and more experience. Additionally, Lewis was a little sceptical when he appeared at
the hospital’s emergency department. This was due to his previous experience at another hospital
where he faced discrimination due to his aboriginal connections. He, therefore, felt that he could
not be offered quality care as required by the scope of nursing practice. It took a lot of
convincing to make him believe that quality care was guaranteed at our facility. There were also
a lot of doubts about cultural safety because he had not been treated by a doctor who clearly
understood the aboriginal culture. He even believed that this lack of cultural safety and
understanding was the basis of the discrimination he faced. I, therefore, had to show him that I
was ready to provide culturally safe care that was patient-centred.

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Health Issue
The physical, emotional, mental, and psychological wellbeing of the indigenous Australians has
been ignored for a long time now. It is important to note that most Australian aboriginals
experience poor health outcomes as compared to their non-aboriginal counterparts. Most of the
health issues that they face include cardiovascular diseases, respiratory complications, diabetes,
mental health illnesses, and chronic kidney diseases. In recent years, there has been an increased
risk of other conditions such as trachoma and rheumatic heart disease (Marijon, Mirabel,
Celermajer & Jouven, 2012). The gap in healthcare outcomes between the aboriginals and non-
aboriginals could also be contributed by the massive use of tobacco and illicit substances among
the indigenous Australians (Gracey, 2014).
Cardiovascular diseases such as the heart attack experienced by Lewis contribute to the reduction
in life expectancy among the Aboriginal and Torres Strait Islander people. Studies have revealed
that the aboriginals are likely to die around 11 years earlier than their non-aboriginal counterpart
(Lawrence, Hancock & Kisely, 2013). Between 2002 and 2005 cardiovascular-related diseases
contributed to approximately 27% of total deaths among the aboriginal Australians and Torres
Strait Islanders (Australian Institute of Health, 2012).
The rate of smoking among the Aboriginal and Torres and Strait Islanders is very high and this
increases the risk of cardiovascular diseases among the aboriginals such as my client Lewis.
Additionally, the poor health status of the aboriginals that is majorly contributed by the
discrimination they face puts them at a bigger risk of experiencing this health issue. Studies
reveal that people aged between 20 and 35 years like Lewis are increasingly at a high risk of
heart attack and ischaemic heart disease (McGrady et al., 2012). Ischaemic heart disease is the
biggest contributor of aboriginal deaths especially among the youths with 12% compared to just

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3.8% among the non-aboriginals (Australian Institute of Health, 2012). These factors are some of
the massive factors that put my client Lewis at a high risk of experiencing this health issue.
Cultural Concepts
Several cultural barriers affect the delivery of care among the Aboriginals. As a result, the health
outcomes of these patients are massively affected. Some of these factors include the use of
indigenous language, the strength of identity, and the connection to the community of origin.
According to Larkins et al. (2016), the aboriginal Australians together with the Torres Strait
Islanders are the most underprivileged economically, culturally, and even politically. The
challenge of non-equitable care for the aboriginals has been longstanding despite the attempts of
the government and communities to improve care delivery and improve health outcomes ("Home
- Australian Institute of Health and Welfare", 2019). It is therefore important to note that health
inequities are very often among the aboriginal communities and cultural concepts and factors are
fundamental in addressing these inequalities (Durey & Thompson, 2012). Healthcare
practitioners must, therefore, do all within their capabilities to get rid of racial and cultural
discrimination in the healthcare setting. The position of nurses in the provision of care for the
aboriginals is crucial because the can initiate and sustain contact with these group of
discriminated individuals (Li, 2017). The nurses can additionally intervene when the community
needs them most to address social issues and socially significant issues in healthcare.
The existence of health inequities among the Aboriginals and Torres Strait Islanders hinders their
access to quality healthcare. The indigenous Australians experience high infant mortality rates
and the rates of age-standardized deaths because of their cultural differences and socioeconomic
disparities (Steenkamp, Rumbold, Barclay & Kildea, 2012). These same factors affect the
situation of chronic diseases such as diabetes and cardiovascular health conditions.

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It is important to note that cultural barriers are very fundamental in addressing the health
inequalities of the aboriginals. Healthcare availability depends on a lot of things one of them
being cultural support. Cultural barriers such as language differences and conceptions about
sexuality and gender can lead to ineffective communication between patients and nurses if they
come from different cultural backgrounds (Mobula et al., 2015). As a result, the health outcomes
become unsatisfactory to the aboriginal Australians. Mobula et al. (2015) further state that
different beliefs, faiths, and varying interpretations about health and identity make the
aboriginals less willing to access healthcare. Language is the main cultural component and a
difference in language leads to ineffective communication thus leading to failures in healthcare.
Healthcare should, therefore, be specifically tailored to suit the aboriginals and improve care
outcomes.
Professional Responsibilities
I understand and acknowledge the fact that it is my responsibility as a nurse to provide patient-
centred and culturally safe care for my patients. The aboriginal Australians face a lot of health
issues that need to be adequately addressed. One of the most serious health issues facing the
Aboriginal and Torres Strait Islanders is cardiovascular diseases. In my previous practice as a
student nurse I handled several aboriginals from different cultural backgrounds and I believe that
I understand the challenges they face in accessing healthcare services. My past experiences have
influenced my approach to care and I believe they have shaped my professional responsibilities
to suite the aboriginals.
I have previously been reluctant in trying to understand the background of a patient and put
myself in their situation. Lack of cultural understanding jeopardizes the delivery of care and
prevents health practitioners from offering culturally safe care (Montenery, Jones, Perry, Ross &

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Zoucha, 2013). Patients appreciate being attended to by healthcare practitioners who they can
relate to culturally. This means that they feel more comfortable with nurses from their culture or
those who understand their culture (Montenery et al., 2013). It is therefore important as a nurse
that I modify my practice to ensure that my patients can feel confident in me during the delivery
of care. This will involve building a patient-nurse relationship with my patients. A patient-nurse
relationship is normally built on mutual respect and trust thus ensuring that a patient gains the
appropriate emotional, mental, and physical support to help with a full recovery. In my future
practice, I intend to make my patients feel that I am genuinely interested in knowing their life,
culture, and situation. This is another way of establishing a therapeutic patient-nurse relationship
for better health outcomes.
Cultural Safety
Nurses have the responsibility of providing care that ensures the best possible health outcome for
a patient. This can only be made possible when the nurse works in partnership with the patient.
Additionally, nurses are obligated to engage with all their patients in a culturally safe manner
that fosters open and honest relationships (Taylor & Guerin, 2019). I believe that if Australia has
to realize that every patient including the Aboriginal and Torres Strait Islanders, then all
healthcare centres must embrace the aspect of cultural safety. As a nurse, I intend to practice
cultural safety in future by examining my behaviours, beliefs, and practices. Additionally, I will
examine issues like institutional racism to ensure that my patients receive culturally safe care.
Some of the requirements that will ensure that resources and services are distributed to all
patients in a culturally safe manner include cultural knowledge, cultural competence, access, and
alternate services. Cultural knowledge involves the nurse or practitioner being self-aware of their
own culture before they can understand the culture of the patient. Being culturally aware helps a

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clinician in understanding the cultural beliefs and requirements depending on the type of health
issue being addressed (Thackrah & Thompson, 2013). As a nurse, I will take it upon myself to be
culturally aware of my culture and also to try and learn other cultures of Australian aboriginals to
ensure the delivery of culturally safe care.
Cultural competence is closely related to cultural safety and it ensures that patients receive the
best possible care. Cultural competence ensures that the nurse is culturally aware and
knowledgeable about other cultures different from their own (Garneau & Pepin, 2015). As a
result, a nurse provides care that meets the cultural and social needs of the patient. As a nurse, I
plan to employ the aspect of cultural competence in my future practise to improve the quality of
health outcomes and get rid of any racial or ethnic forms of discrimination.
Conclusion
Patient-centred and culturally safe care are important aspects of the nursing practice that ensure
that quality health outcomes are achieved. A patient-centred approach to care ensures that the
specific health needs and the health outcomes that are desired by an individual form the basis of
all the healthcare decisions. Cultural safety, on the other hand, ensures that the nurse is
empowered to understand and relate to the social and cultural setting of a patient to ensure
quality health outcomes. Healthcare in Australia is not equitable and most Australian aboriginals
experience poor health outcomes as compared to their non-aboriginal counterparts. Most of the
health issues that they face include cardiovascular diseases, respiratory complications, diabetes,
mental health illnesses, and chronic kidney diseases. These inequalities in care are due to the
various cultural barriers facing the Aboriginal and Torres Strait Islanders. Lack of cultural
understanding jeopardizes the delivery of care and prevents health practitioners from offering

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culturally safe care. It is therefore important that healthcare facilities prioritize cultural safety to
ensure that patients receive the desired quality of care.
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