Implementing Cultural Competence And Safety In Aged Care Setting

Defining Cultural Competence and Safety

The following website may assist with this Q

http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129548151

Part A

Define cultural competence and cultural safety, and in your own words describe how you could implement them in an aged care setting.

Part B

Discuss resources that are available in the nursing home and the community to promote understanding and promote partnerships?   

Part C

How are organisational policies and procedures devised and documented in the nursing home to ensure that the care provided meets the needs of the residents?

The following websites may assist with this Q

http://australia.gov.au/about-australia/australian-story/austn-indigenous-cultural-heritage

http://www.multiculturalaustralia.edu.au/doc/shnukal_torres_strait.pdf

Aboriginal and Torres Strait Islander culture varies throughout the continent and islands, with different areas having different language, traditions, foods, ceremonies and technologies.

Part A

Research an Aboriginal culture and a Torres Strait Islander culture and identify the specific areas of cultural difference for each.

Area of cultural difference	Aboriginal	Torres Strait Islander
Language
Traditions
Foods
Ceremonies
Technologies ie. To acquire food, for art, for work etc.
Specific location in Australia

Part B

How would you and your colleague support effective partnerships between you and the two cultures?

The following websites may assist with this Q 

http://www.community.nsw.gov.au/__data/assets/pdf_file/0017/321308/working_with_aboriginal.pdf 

http://www.australia.gov.au/about-australia/australian-story/austn-indigenous-cultural-heritage 

Part A

Due to the diversity within and between Aboriginal cultures and Torres Strait Islander cultures, protocols will vary and community care workers are encouraged to be aware of the sensitivity surrounding these issues and to consult with appropriate local Aboriginal community members and Torres Strait Islander community members to discuss any matters that arise.

List five or more cultural practices and issues that are sensitive to Aboriginal peoples and Torres Strait Islander peoples.

Part B

Identify cultural safety issues and practices in the nursing home.  Discuss the strategies that are implemented to ensure cultural safety and build effective partnerships between staff, Aboriginal and/or Torres Strait Islander people and their communities.

he following website may assist with this Q 

https://www.dss.gov.au/our-responsibilities/settlement-and-multicultural-affairs/publications/connections-an-employers-guide 

It is recognised and accepted that a suitably supportive and stable working environment for Aboriginal and Torres Strait Islander people is likely to help redress the social injustices, exploitation and socio-economic and employment inequities especially affecting Aboriginal and Torres Strait Islander people.  Outline how you can support culturally diverse workers.

The following website may assist with this Q http://sielearning.tafensw.edu.au/MCS/9362/Sterilisation%20disk%203/lo/7374/7374_00.htm

All people have the right to be treated with dignity and respect. When working in a health care setting there is potential for cultural conflict and misunderstandings to occur which may result in a person in need of assistance not accessing that assistance.

Part A

Identify ways that you as an Enrolled Nurse can prevent cultural conflict or misunderstandings occurring.

Resources for Promoting Understanding and Partnerships

Who would you involve to evaluate and document the interventions?

Part C

How would you evaluate and document the interventions?

The following website may assist with this Q 

https://childaustralia.org.au/Documents/IPSP-Section/Resource-Centre-Docs/cultural-book-complete-WEB.aspx 

You come out from the whitefella world, with your mind, and you going into a different country, like Bali.  Indigenous community like that.  You gotta have that expectation – different culture, different people, live in a different world.  Like when you go on a holiday, you don’t rush, rush, rush.  You relax and enjoy yourself.  Then you learn.  Then people can accept you. Indigenous early childhood educator.  

Enrolled nurses need to be aware that their own values and beliefs can be passed on to co-workers and others through language, interaction and the curriculum. Discuss how nurses can have an understanding and show respect, diversity and cultural competency in the health sector.

The following websites may assist with this Q 

http://www.mmigp.org.au/resources

http://www.healthinfonet.ecu.edu.au/key-resources/organisations?oid=1471 

https://www.sa.gov.au/topics/community-support/resources-for-aboriginal-people 

Enrolled nurses must ensure that Aboriginal and Torres Strait Islander people are partners in their health care.

Research some resources / services in the community that can be used to assist Aboriginal or Torres Strait Islander families in the community.

The following website may assist with this Q 

http://www.redcross.org.au/aboriginal-and-torres-strait-islander-peoples.aspx

Some Aboriginal and Torres Strait Islander families need additional support for a variety of reasons. Outline the support that workers can provide and organisations can implement.

The following website may assist with this Q 

http://www.carersaustralia.com.au/storage/2011Working%20with%20Aboriginal%20People%20and%20Communities.pdf 

“She just has this thing about her”

Indigenous Parent

Part A

Reflect on your studies to date.  Describe the characteristics that you believe would be important when working with Aboriginal and Torres Strait Islander clients, families, children and colleagues.

Part B

There may be times that a health care setting may require the expertise of external services.  Outline when you would use

• A language interpreter

• A cultural interpreter

• A translator

Part C

It is important to evaluate and measure programs against desired outcomes. How would you evaluate and measure the success of using an interpreter?

The following websites may assist with this Q 

http://www.csu.edu.au/__data/assets/pdf_file/0004/409459/Guide-for-Working-with-Indigenous-Australian-Staff_-WEB.pdf

Even when we are thoroughly aware of all the barriers to effective cross-cultural communication and make use of available aids and tools to assist us in communicating with people from cultural and linguistic backgrounds different to our own, misunderstandings will occur.

“What do you do?”

In the dominant culture of Australia and indeed in Western cultures more generally, there is a tendency to associate a person’s social value and worth with their occupation and to socially position them accordingly. “What do you do?” is often one of the first Qs asked in social situations.

Organisational Policies and Procedures

“Who you is?”

When an Aboriginal person in Wilcannia asks ‘who you is?’ of another Aboriginal person, the response being sought locates a person relationally—for example: ‘I’m X’s nephew’ or ‘my Mother is A’ or ‘Y is my cousin’. In responding to Qs such as this, Aboriginal people explore kin relationships and social networks across towns and cities. This serves to socially and geographically locate the people being met, thereby positioning them within recognised frameworks and the kind of social intercourse that may or may not be entered into.

For many Aboriginal people, work and its rewards sit uneasily with the upholding of a distinct identity. They recognise that regular employment affords some of the material things that many would like to have, but are not prepared to forfeit other culturally perceived and culturally attributed values, social obligations and desires (as well as the time to fulfil these). Family illness, Nana’s need to do some shopping, the arrival of family or friends from out of town or an unexpected occurrence of interest continue to be some of the causes of much non-attendance at ‘work’.

Discuss how a health care service can support Aboriginal and Torres Strait Islander people to fulfil all needs of cultural, family and work obligations.

The following website may assist with this Q 

http://www.winnunga.org.au/

As an Enrolled Nurse in an inner city suburb you notice that more Indigenous families are attending the community care centre than ever before. This has occurred because the community care centre manager has actively engaged the Indigenous community and has employed several Indigenous community care workers, and has now an external Indigenous stakeholder group to refer to if needed and on an ongoing basis.  There is a need for relevant Indigenous resources to address cultural realities, and to support effective service delivery. What are some ways that would contribute to meeting these needs?

The following website may assist with this Q http://www.carersaustralia.com.au/storage/2011Working%20with%20Aboriginal%20People%20and%20Communities.pdf

A new Indigenous community care worker has just started and during her orientation she observes the community care centre receptionist speaking disrespectfully to an Indigenous cleaner. She is unsure what to do as she really needs the job and does not want to put her job at risk or create a big problem. After some weeks when she understands her colleagues better, she confides in you as the Enrolled Nurse, and asks what she should do. How would you approach this problem?

To provide culturally safe nursing practice, it is important to have an understanding of historical and cultural backgrounds of Aboriginal and Torres Strait Islanders in Australia.  Research events from European invasion and discuss the impact of same on Aboriginal and Torres Strait Islander people.

Part A

From research, outline the events and how they may have impact client’s social, emotional, physiological and physical wellbeing.

Part B

Considering your clients, what are the most common diseases experienced.

Part C

How do you involve your clients in the planning and delivery of their health care?

Defining Cultural Competence and Safety

Part A

Cultural safety can be defined by the concept of implementing and engaging in the practices that has no direct intention of harming or offending the cultural beliefs of any individual associated with the practice or service

Cultural competence can be defined as ability of any care provider to delivery health care services that are in accordance with the social, cultural, and linguistic needs of patients.

I would attempt to adhere to the cultural safety guidelines and exercise absolute inclusion while valuing the beliefs and principles of all patients with equality and justice (Australian Institute of Health and Welfare 2018)

Part B

The nursing practice standards, code of conducts, and code of ethics, either electronic or hard copies.

Part C

The policies are devised in the board meetings with integrating the input from all of the stakeholders and they are documented according to the evidence based practices both electronically and also reserving the hardcopies in a secure and locked yet easily accessible location

Aboriginal and Torres Strait Islander culture varies throughout the continent and islands, with different areas having different language, traditions, foods, ceremonies and technologies.

Part A

Research an Aboriginal culture and a Torres Strait Islander culture and identify the specific areas of cultural difference for each.

Area of cultural difference	Aboriginal	Torres Strait Islander
Language	Pidgin English	Torres Strait Creole
Traditions	Mainland oriented traditions including Dreamtime	Traditions of Melanesian origin
Foods	Australian native plant foods include the fruits quandong, kutjera, muntries, riberry, Davidson's plum, and finger lime. Fish and shellfish are culinary features of the Australian coastal communities	yams, taro, wild yam, cassava, fruits such as wongai, sorbie, coconuts, sea almonds, and meats such as pig, stingray, turtles, dugong, shellfish and fish
Ceremonies	Bora or Burbung, sacred songs, dances, stories, and traditional lore, Circumcision, scarification, and removal of a tooth	formal handover of title, new houses and boats are blessed, tombstones unveiled with Christian ceremony
Technologies ie. To acquire food, for art, for work etc.	Mobile devices, GPS, etc	Mobile devices, GPS, etc
Specific location in Australia	Anangu in northern South Australia, and neighbouring parts of Western Australia and NorthernTerritory. Bama in north-east Queensland. Gunggari in South-west Queensland. Koori (or Koorie or Goori or Goorie) in New South Wales and Victoria	Cape York and Papua New Guinea

 

Part B

How would you and your colleague support effective partnerships between you and the two cultures?

We will incorporate cultural safety and competence by congruent behaviours and attitudes to honour and respect the culture we both belong to and be able to make honest efforts to learn the traditional beliefs and cultures of both of us to serve our culturally diverse patients with optimal efficacy (Australia.gov.au, 2018)

Part A

The issues are: dispossession of land, family fragmentation, grief and loss, racism, unemployment, poverty and social and emotional wellbeing

Part B

There are many common issues that are prevalent in the care setting involving the aboriginals and/or Torres strait islanders. These issues are associated with respect and sensitivity, use of appropriate language, communication technique or approach, establishing therapeutic relationship and rapport, bias and cultural participation. The strategies that are implemented include Brighter Futures and the Aboriginal Maternal and Infant Health Strategy to improve their health, engagement and communication strategies, NATISWA framework, etc. The strategies mainly focus on enhancing the cultural safety and competence in communication, language and tone of voice, along with care practices integrated with the traditional beliefs of health (Community.nsw.gov.au 2018).

Resources for Promoting Understanding and Partnerships

It is recognized and accepted that a suitably supportive and stable working environment for Aboriginal and Torres Strait Islander people is likely to help redress the social injustices, exploitation and socio-economic and employment inequities especially affecting Aboriginal and Torres Strait Islander people.  Outline how you can support culturally diverse workers .

In order to support the culturally diverse workers, first and foremost, equality and justice is needed to be implemented. It is very important for the culturally diverse workforce to feel included and respected in the work environment; hence I will ensure to facilitate utmost respect and inclusion for the culturally diverse workforce (Shah 2012). Additionally, I will take initiative to engage them in our festivities and traditions and also celebrate their traditional festivities to promote a healthy inclusive culture. As discrimination and bullying is considered to be one of the greatest contributors to workplace related issues for aboriginals, I will ensure to implement a zero tolerance policy against any bullying or discrimination. Along with that, I will have weekly feedback sessions to ensure that the culturally diverse workforce has a chance to express their grievances or issues (Community.nsw.gov.au., 2018).

Part A

An enrolled nurse will prevent or manage cultural conflict or misunderstanding by a series of steps involving:

• Identifying issues that may cause conflict
• calculating the impact of impact of cultural differences
• sensitively resolve differences, taking cultural considerations into account
• Addressing any difficulties with appropriate people and seek assistance when required (tafensw.edu.au 2018)

Part B

I will involve the registered nurse and my nursing supervisor along with the HR or any other administrative representative.

Part C

In order to evaluate and document the interventions I would conduct one to one private meetings with the parties involved in the conflict and I will document them in the conflict management register and in my personal reflection journals.

You come out from the whitefella world, with your mind, and you going into a different country, like Bali.  Indigenous community like that.  You gotta have that expectation – different culture, different people, live in a different world.  Like when you go on a holiday, you don’t rush, rush, rush.  You relax and enjoy yourself. Then you learn.  Then people can accept you. Indigenous early childhood educator.  

Enrolled nurses need to be aware that their own values and beliefs can be passed on to co-workers and others through language, interaction and the curriculum. Discuss how nurses can have an understanding and show respect, diversity and cultural competency in the health sector.

Personal values, beliefs and principles have a significant impact on the professional practice, especially when it involves providing care to the different individuals. As a result it is crucial for the nurses have a strong principle and values that respect the cultural differences and prioritizes compassion and justice over anything else (Gerlach 2012). A nursing professional can easily develop understanding and show respect by interacting with the different cultures or take up any cultural competence courses. Along with that, there are various online resources available that provide information to help the nurses develop a better understanding of cultural safety and competence and the nurses can develop their understanding skills with the help of the resources (Jeffreys 2015).

Organisational Policies and Procedures

The resources or services that can be used in order to assist the aboriginal and Torres Strait Islander families include:

Indigenous Network Victoria that promotes leadership activities, support leadership opportunities, develop leadership capacity, support leaders and improve existing Indigenous leadership initiatives in the Indigenous community

Koori heritage trust and mail, a not-for-profit Aboriginal community organisation that aims to protect, preserve and promote the living culture of Aboriginal people of south-eastern Australia, along with the mail which is fortnightly distributed Australia-wide.

Other notable resources include Nganampa Health Council, aboriginal drug and alcohol council, Reconciliation Australia, Aboriginal Family Violence Prevention and Legal Service Victoria, Aboriginal Family Support Services, Australian Indigenous HealthInfoNet, etc (Sa.gov.au., 2018)

The aboriginals might require a series of additional support services in order to learn and implement the health promotional behaviours alike the rest of the mainstream society and hence the health care workers often have to provide additional support to the needy. First and foremost, counselling support is often the most abundantly used by the aboriginals and the Torres Strait Islanders. The counselling support is often provided in both community setting and one to one setting (Kirmayer 2012)

The health literacy of these minority groups is often very low and hence along with mental health support, they often require additional patient education which is provided by the care professionals in accordance to evidence based culturally safe practice.

Part A

Reflect on your studies to date.  Describe the characteristics that you believe would be important when working with Aboriginal and Torres Strait Islander clients, families, children and colleagues.

There are various characteristics that are needed to be taken into consideration while working with the indigenous families, children and colleague. First of all, the nurses must respect the cultural sensitivity issues and take a compassionate and respectful communication approach both verbal and nonverbal (Funston 2013). Even gesture, tone of voice or lack of eye contact can seem rude and disrespectful to an aboriginal or TSI. Cultural bias and building rapport is also a very important characteristic feature that is needed to be adhered to with sensitivity while working with aboriginals (Carersaustralia.com.au., 2018).

Part B

There may be times that a health care setting may require the expertise of external services.  Outline when you would use

• A language interpreter

When the culturally diverse family has low English language proficiency

• A cultural interpreter

When the culturally diverse client or family is demanding traditional healing techniques or is expressing any cultural norm to be followed.

• A translator

Cultural Differences between Aboriginal and Torres Strait Islander Cultures

When the culturally diverse family or client cannot understand medical instructions at all

Part C

It is important to evaluate and measure programs against desired outcomes. How would you evaluate and measure the success of using an interpreter?

I would use a feedback assessment tool to ensure that the communication between the care team and the patient or their family is effective and both parties have understood the communication clearly.

Even when we are thoroughly aware of all the barriers to effective cross-cultural communication and make use of available aids and tools to assist us in communicating with people from cultural and linguistic backgrounds different to our own, misunderstandings will occur.

“What do you do?”

In the dominant culture of Australia and indeed in Western cultures more generally, there is a tendency to associate a person’s social value and worth with their occupation and to socially position them accordingly. “What do you do?” is often one of the first questions asked in social situations.

“Who you is?”

When an Aboriginal person in Wilcannia asks ‘who you is?’ of another Aboriginal person, the response being sought locates a person relationally—for example: ‘I’m X’s nephew’ or ‘my Mother is A’ or ‘Y is my cousin’. In responding to questions such as this, Aboriginal people explore kin relationships and social networks across towns and cities. This serves to socially and geographically locate the people being met, thereby positioning them within recognised frameworks and the kind of social intercourse that may or may not be entered into.

For many Aboriginal people, work and its rewards sit uneasily with the upholding of a distinct identity. They recognise that regular employment affords some of the material things that many would like to have, but are not prepared to forfeit other culturally perceived and culturally attributed values, social obligations and desires (as well as the time to fulfil these). Family illness, Nana’s need to do some shopping, the arrival of family or friends from out of town or an unexpected occurrence of interest continue to be some of the causes of much non-attendance at ‘work’.

Discuss how a health care service can support Aboriginal and Torres Strait Islander people to fulfil all needs of cultural, family and work obligations.

In order to support the needs of cultural family and work obligations, Aboriginal and Torres Strait Islander people often require the attention of a few resources. Firstly, the services can help the ATSI individuals understand their obligations and their implications in life. It has to be understood that the native communities are not much aware of the modern societal norms, and hence, helping them understand the obligations and what they are required to do can be extremely helpful. Another way they can be helped includes providing additional support or key resources so that they can fulfil their obligations, including financial support as well (Brown et al. 2016).

Supporting Effective Partnership

Resources are undoubtedly a very important contributor to the evidence based practice, and hence, the need for the resource delivery is needed to be addressed across all domains. The Winnunga Nimmityjah Aboriginal Health Services can be a very important service that can be helpful for the aboriginal community centre with culturally diverse staff that can better address the cultural realities. They are a Aboriginal community controlled primary health care service that is run by the Aboriginal and Torres Strait Islander community so that they can be able to address the care needs of the aboriginals with much better understanding of the traditional health needs of the ATSI people. However, there are other such services as well that are run by aboriginal staff and the community centre can benefit from and can improve the care standards and delivery to the ATSI people.

As an enrolled nurse, I will ask her to formally report the issue and will conduct a private one-to-one meeting or consultation session with her helping her understand the legal process of filing a culturally safety complaint against a co-worker. After she has understood the legal procedure I will assist her to arrange a meeting with my supervisor and take her guidance regarding how to proceed with the complaint. With her guidance, I will proceed to instruct and help the new worker file a formal complaint mail to the administrative department. Next, I will conduct a meeting with both of the parties involved so that the receptionist can provide her side of the story or any justification for her actions. Depending on her responses, she will be either left with a formal warning or a more severe punishment. I would personally reassure the worker regarding the liberty for the workers to report any unprofessional attitude or offensive behaviour of co-workers immediately following the protocol (Carersaustralia.com.au., 2018).

Part A

From research, outline the events and how they may have impact client’s social, emotional, physiological and physical wellbeing.

Part B

Considering your clients, what are the most common diseases experienced.

Part C

How do you involve your clients in the planning and delivery of their health care?

References:

Australia.gov.au 2018. Australian indigenous cultural heritage. [online] Available at: https://australia.gov.au/about-australia/australian-story/austn-indigenous-cultural-heritage https://www.multiculturalaustralia.edu.au/doc/shnukal_torres_strait.pdf [Accessed 31 May 2018].

Australian Institute of Health and Welfare. 2018. Reports & statistics - Australian Institute of Health and Welfare. [online] Available at: https://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129548151 [Accessed 31 May 2018].

Baker, A.C. and Giles, A.R., 2012. Cultural safety: A framework for interactions between Aboriginal patients and Canadian family medicine practitioners. International Journal of Indigenous Health, 9(1), p.15.

Brown, A.E., Middleton, P.F., Fereday, J.A. and Pincombe, J.I., 2016. Cultural safety and midwifery care for Aboriginal women–A phenomenological study. Women and Birth, 29(2), pp.196-202.

Carersaustralia.com.au. 2018. Working with aboriginal people and communities. [online] Available at: https://www.carersaustralia.com.au/storage/2011Working%20with%20Aboriginal%20People%20and%20Communities.pdf [Accessed 31 May 2018].

Community.nsw.gov.au. 2018. Working with aboriginal people and communities, a practice resource. [online] Available at: https://www.community.nsw.gov.au/__data/assets/pdf_file/0017/321308/working_with_aboriginal.pdf [Accessed 31 May 2018].

Family & Community Services 2018. All children deserve a safe and stable home for life.. [online] Available at: https://www.community.nsw.gov.au/__data/assets/pdf_file/0017/321308/working_with_aboriginal.pdf https://www.australia.gov.au/about-australia/australian-story/austn-indigenous-cultural-heritage [Accessed 31 May 2018].

Funston, L., 2013. Aboriginal and Torres Strait Islander worldviews and cultural safety transforming sexual assault service provision for children and young people. International journal of environmental research and public health, 10(9), pp.3818-3833.

Gerlach, A.J., 2012. A critical reflection on the concept of cultural safety. Canadian Journal of Occupational Therapy, 79(3), pp.151-158.

Jeffreys, M.R., 2015. Teaching cultural competence in nursing and health care: Inquiry, action, and innovation. Springer Publishing Company.

Kirmayer, L.J., 2012. Rethinking cultural competence. Transcultural psychiatry, 49(2), p.149.

Sa.gov.au. 2018. SA.GOV.AU - Resources for Aboriginal people. [online] Available at: https://www.sa.gov.au/topics/care-and-support/resources-for-aboriginal-people [Accessed 31 May 2018].

Shah, C.P., 2012. Increasing Aboriginal cultural safety among health care practitioners. Canadian Journal of Public Health, 103(5), p.397.

Sielearning.tafensw.edu.au. 2018. Resolve cross-cultural misunderstandings - Resolve cross-cultural misunderstandings. [online] Available at: https://sielearning.tafensw.edu.au/MCS/9362/Sterilisation%20disk%203/lo/7374/7374_00.htm [Accessed 31 May 2018].