NSB202 Assessment: Cultural Safety Impact on Indigenous Well-being

This essay delves into the critical issues of personal and systematic racism and their impact on the well-being of Aboriginal and Torres Strait Islander peoples in Australia, referencing the National Aboriginal and Torres Strait Islander Health Plan 2013-2023. It highlights the power dynamics associated with 'whiteness' and its influence on contemporary nursing practices, contributing to health inequities. The essay compares cultural safety and cultural competence, emphasizing the importance of addressing historical injustices and power imbalances in healthcare. Through reflection on the Close the Gap Strategy, it underscores the need for holistic approaches that consider social determinants of health. Furthermore, it examines the effects of institutional racism, particularly the historical events like European settlement and protection policies, on indigenous communities, leading to disparities in education, employment, and healthcare access. The essay concludes by advocating for culturally safe nursing practices as a means to address institutional racism and improve health outcomes for indigenous Australians, emphasizing the role of cultural competence training and respectful care delivery.

Running head: WELL-BEING
Well-being
Name of the student:
Name of the University:
Author’s note

1.
Comparison between personal racism and systematic racism:
Personal racism is a concept that involves experience of discrimination or stereotyping
based on racial differences and differences in values and behaviour of a person as per racial and
cultural different. In contrast, institutional or systematic racism is a form of racism expressed by
political or social institution resulting in disparities in the area of housing, income, employment,
justice, wealth and health care. Hence, personal racism is a type of discrimination linked to
values, attitudes, feelings and opinion and institutional racism is linked to discrimination
occurring due to policies, procedures, systems and practices (Payne, Vuletich & Lundberg,
2017). One example can also clear define the difference between personal racism and
institutional racism. For example, if a person is not allowed to enter a hotel because of his race, it
is a type of personal racism situation. In contrast, if a company restricts hiring people from a
specific racial group, it is an example of institutional racism.
Impact of power dynamics on contemporary practice in Australia:
Many people are discriminated based on their colour. Whiteness is a concept related to
those groups of individuals who enjoy certain privileges in society because of their power
dynamics. It is a cultural norm where certain groups are positioned at the top of the cultural-
racial hierarchy not because of biological category but because of white as a social construction.
These groups of people enjoy rights, benefits and advantages beyond those enjoyed by other
individuals in the society (Molloy, 2017). Hence, the imbalance of power and inequity is the
main factor that defines the white group and the impact of power facilitates domination of the

white group in society. The superiority of the whites over non-white ethnic groups informs
institutional culture and practices too.
The whiteness concept relate to contemporary nursing practice in Australia too because
white group enjoy many privileges within health care service and inequities exists in relation to
health access and availability of care for the disadvantaged groups like the indigenous
Australians. Durey and Thompson (2012) give the evidence regarding the effect of white Anglo-
Australian cultural dominance in health service delivery to indigenous Australian. Many nurse
are only involved in discriminating the indigenous people because they have negative attitude
towards indigenous people and the indigenous beliefs are subjugated to the dominant western
biomedical model in Australian health care system.
Comparison between cultural safety and cultural competency:
Cultural competence is defined as the set of skills, values and behaviours needed to meet
social, cultural and linguistic needs of different client group. On the other hand, cultural safety is
a list of expected behaviour that ensures respect for culturally and socially diverse client group in
health services (Holland, 2017). Hence, cultural safety is a competence that can come under the
provision of cultural competence. Cultural safety exemplifies both cultural awareness and
cultural sensitivity. However, the difference between the two concepts is that cultural safety is
term mainly focussed on the causes of inequality whereas cultural competence is a term that
determines the way in which individual skills and behaviour influence service provision and
addresses the negative impact of colonial history for disadvantaged group.
Cultural safety is often targeted during cultural competence training as it increases staff’s
understanding regarding the need to respect differences and understand the limitations of cultural

competence. It helps to identify the power differences that exist in health service delivery and
appropriately respond to such inequities through structured education. The lens of cultural safety
supports health care staffs to consider impact of racism and prejudice and challenge unusual
power relations (Repo et al., 2017).
2.
Reflection on one prescribed readings:
Report: One of the week 1-5 readings that grabbed my attention includes the 10 year review of
the Close the Gap Strategy by Close the Gap Campaign Steering Committee (2018) because it
gave me idea regarding the actions that Australian government has taken so far to meet the goals
of the Close the Gap strategy.
Respond: I am overwhelmed by the reading as it developed my understanding that despite great
investment by Australian government, they are still not able to meet complex health needs of
Aboriginal and Torres Strait Islander peoples.
Relate: My personal understanding was that government investment in different areas of health
care would resolve poor outcomes of indigenous people. However, after reading the 10 year
review, I developed the idea that critical thinking is needed to ensure that investment is made in
the right areas for promotion of indigenous health.
Reasoning: I got to learn that focussing on holistic factors of well-being such as addressing the
social determinants of health is vital for indigenous people because proper housing, employment
and health infrastructure also influence the engagement of indigenous people with the health care
system (Gee et al., 2014).

Reconstructing: With this knowledge, I have gained knowledge regarding the importance of
cultural sensitivity to prepare appropriate well-being plan for disadvantaged group. I plan to
develop my cultural competence so that I can address disadvantage and promote equality for the
indigenous people.
3.
Effect of institutional racism in Australia:
Institutional racism has significantly influenced the lives of indigenous people in
Australia. Throughout the Australian history, the indigenous group has suffered from
disadvantage because of dominance of white and the existence of institutional racism.
Government policies and laws also favoured the white groups like Europeans and increased
sufferings and disadvantages for the indigenous people. This was the reason for loss of their
lands, forced migration and economic distress due to poor employment and education
opportunities. One of the historical events that significantly influenced the lives of indigenous
people included the European settlement. As English explorer Captain James Cook claimed
eastern portion of the Australian continent, this resulted in dispossession of land, death and
accelerate sufferings for the indigenous community. As they had to migrate to new land, they
failed to get appropriate employment and provide basic education to their children (Snyder &
Wilson, 2015). The event of European settlement is linked to white privilege as the European
used their power to eliminate the black races. The protection policy further promoted
institutional racism for indigenous group and results in discrimination in relation to education
and employment. Due to these historical experiences, the children of indigenous Australians are
known as stolen generation as they were placed in foster care and did not get basic amenities for

good living (Biddle, Khoo & Taylor, 2015). In the area of education, one example of institutional
racism includes poor attendance of indigenous children in schools because of lack of recognition
of indigenous culture and history in school, poor engagement of parents in education and
presence of disadvantage in many areas of life for indigenous Australians (Purdie & Buckley,
2010).
Institutional racism is a major cause behind poor access to health care and disparities in
health outcomes for indigenous Australians too. Health care system has not adapted culturally
appropriate policies to ensure that language and cultural support related issues are addressed.
Cultural barriers like language gap, poor cultural sensitivity among health care staffs and
differences in health beliefs and interpretation about health between indigenous people and
health care staffs has resulted in poor access to mainstream health care facilities and lack of
motivation to visit health care service (Li, 2017). Durey et al. (2016) gives the evidence that
many indigenous Australians lack the motivation to visit health care service and seek treatment
because they experience discrimination by health care staffs. Their religious beliefs and courtesy
were not respected by staffs and they had different opinions about the utility of treatment for
them. This justifies why indigenous Australians have poor health outcome and mortality rate
compared to non-indigenous group. The poor experience of indigenous people in health care is
also related to the concept of white privilege because health care system in Australia is
dominated by the white group and it lacks indigenous health care staffs who understand cultural
needs of Aboriginal group in care. Health services lack commitment to develop effective
partnership with local aboriginal communities and provide responsive care to the indigenous
people.
4.

Impact of culturally safe nursing practice on addressing institutional racisms:
Culturally safe nursing practice involves delivery of care that respects cultural needs of
indigenous people and reduces risk of non-compliance to treatment because of violation of
cultural beliefs of indigenous people. Cultural safe practice can address personal and institutional
racism because this form of practice enables nurse to deliver care by considering the cultural
values, behaviour and background of people (Richardson, Yarwood & Richardson, 2017).
Hence, it reduces poor access to care or poor experience in care because of increase in
knowledge regarding cultural preferences of indigenous group. It enables tailoring service
delivery according to the needs and preferences of specific communities (Bainbridge et al.,
2015). Hence, culturally safe nursing practices involve utilization of the cultural competence
skills and cultural safety knowledge while delivering care. This ensures that Indigenous people
do not feel disrespected or violated while coming in contact with nurses and they become
satisfied with the care received.
There are many evidences regarding achievement of positive health outcomes for
indigenous people by means of culturally safe practice. For example, cultural sensitive training
has helped nurse to improve participation in health care for Indigenous Australians and increased
their satisfaction with care. Butler et al. (2016) reports that culturally safe practice improves
outcome and quality of care, makes the care delivery more efficient and effectives, increases
patient’s satisfaction with care and reduces cost associated with care.
5.
Report: During my past week learning activity, I got the opportunity to complete activities on
cultural competences and its role in influencing health outcome for indigenous Australians. By

engaging in the activity and reviewing several readings related to the task, I have understood that
nurse’s cultural competence and knowledge plays a vital role in addressing diverse health needs
of Aboriginal and Torres Strait Islander people and reducing disparities in their health outcome.
Respond: By completing the class activity, I got to learn that indigenous people suffer from poor
health experience because of personal and institutional racism. The review of cause behind
disparities in health outcome of indigenous and non-indigenous population group in Australia
revealed that poor experiences in care, poor cultural sensitivity of nursing staffs and lack of
respect for their cultural needs is a barrier for them in seeking care (Durey & Thompson, 2012). I
am overwhelmed by the manner in which the white privilege and institutional racism has
affected health and well-being for the group. However, I also feel delighted to learn that there is
scope for nurse to improve the situation of indigenous people by engaging in culturally safe
practice. By this activity, I realize the importance of cultural competency skills of nurse in
addressing discrimination and barrier to health care access for patient.
Relate: Before completing this activity, my personal understanding was that indigenous people
are themselves responsible for poor health outcome. However, by completing the activity, I got
the knowledge that several systemic barriers and lack of process for equal access to health and
education has increased risk of chronic disease and health related disadvantage for patient.
Irrespective of systematic disadvantage and injustice for the group, cultural competence training
and engagement of nurse in culturally safe care is a solution to poor health for the group (Butler
et al., 2016).
Reason: I regard the role of nurse as vital in promoting health and well-being for indigenous
people after reviewing evidence regarding how culturally safe care improved health outcomes for

the group. For example, Govere and Govere (2016) revealed cultural competence training is an
effective intervention that empowers nurses and other health care providers in providing
culturally competent care. Delivery of this form of care was significantly associated with
increase in patient satisfaction. Hence, nurse can remove disadvantage and change attitude or
beliefs of indigenous group towards health service by being sensitive to the cultural needs,
respecting their cultural preferences during care and working to address response while delivery
care. Hence, as I aspire to become a nurse, I would use my experience in this activity to take
training on cultural competence so that I can reduce discrimination in related to health access for
the group.
Reconstruct:
While reflecting on the key lessons learnt, I can say that cultural difference between
service care provider and indigenous Australian is major issue within the health care system. I
have learnt that by providing culturally safe nursing practice, nurse can consider power relation,
cultural difference, rights of patient and reflect on their own attitude to improve service provision
(Alizadeh & Chavan, 2016). I aim to use the framework of cultural competence to efficiently
deliver care and respect diversities of the Aboriginal and Torres Strait Islander community.

References:
Alizadeh, S., & Chavan, M. (2016). Cultural competence dimensions and outcomes: a systematic
review of the literature. Health & social care in the community, 24(6), e117-e130.
Bainbridge, R., McCalman, J., Clifford, A., & Tsey, K. (2015). Cultural competency in the
delivery of health services for Indigenous people. Retrieved from:
https://www.aihw.gov.au/getmedia/4f8276f5-e467-442e-a9ef-80b8c010c690/ctgc-
ip13.pdf.aspx?inline=true
Biddle, N., Khoo, S. E., & Taylor, J. (2015). Indigenous Australia, white Australia, multicultural
Australia: the demography of race and ethnicity in Australia. In The international
handbook of the demography of race and ethnicity (pp. 599-622). Springer, Dordrecht.
Butler, M., McCreedy, E., Schwer, N., Burgess, D., Call, K., Przedworski, J., ... & Kane, R. L.
(2016). Improving cultural competence to reduce health disparities.
Close the Gap Campaign Steering Committee. (2018). A ten-year review: the Closing the Gap
Strategy and Recommendations for Reset. Retrieved from:
https://www.humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-
justice/publications/close-gap-10-year-review
Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous Australians:
time to change focus. BMC health services research, 12(1), 151.
Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., & Bessarab, D.
(2016). Improving healthcare for Aboriginal Australians through effective engagement
between community and health services. BMC health services research, 16(1), 224.

Gee, G., Dudgeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait
Islander social and emotional wellbeing. Working together: Aboriginal and Torres Strait
Islander mental health and wellbeing principles and practice, 2, 55-68.
Govere, L., & Govere, E. M. (2016). How effective is cultural competence training of healthcare
providers on improving patient satisfaction of minority groups? A systematic review of
literature. Worldviews on Evidence
‐Based Nursing, 13(6), 402-410.
Holland, K. (2017). Cultural awareness in nursing and health care: an introductory text.
Routledge.
Li, J. L. (2017). Cultural barriers lead to inequitable healthcare access for aboriginal Australians
and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207-210.
Molloy, L. (2017). Nursing care and indigenous Australians: An
autoethnography. Collegian, 24(5), 487-490.
Payne, B. K., Vuletich, H. A., & Lundberg, K. B. (2017). The bias of crowds: How implicit bias
bridges personal and systemic prejudice. Psychological Inquiry, 28(4), 233-248.
Purdie, N., & Buckley, S. (2010). School attendance and retention of Indigenous Australian
students. Retrieved from: https://research.acer.edu.au/cgi/viewcontent.cgi?
article=1045&context=indigenous_education
Repo, H., Vahlberg, T., Salminen, L., Papadopoulos, I., & Leino-Kilpi, H. (2017). The cultural
competence of graduating nursing students. Journal of transcultural nursing, 28(1), 98-
107.

Richardson, A., Yarwood, J., & Richardson, S. (2017). Expressions of cultural safety in public
health nursing practice. Nursing inquiry, 24(1), e12171.
Snyder, M., & Wilson, K. (2015). “Too much moving… there's always a reason”: Understanding
urban Aboriginal peoples' experiences of mobility and its impact on holistic
health. Health & place, 34, 181-189.