Dying+for+Cultural+Safety

Name: Sarah Renton Student number: n8321868 Tutor: Colleen Niland



This cultural artefact depicts two graves in the graveyard near my home in Southport. The first picture is of an Islamic grave. The second is of a grouping of Jewish graves. These graves have their own traditional aspects and customs adorned on them. These graves are contained with the same graveyard of pioneer Australians; some graves date back to 1850 and there are Australian military graves here as well. Australia has been long recognised as being a multicultural and diverse society, with a population comprising of 200 different nationalities, 116 religions and 180 languages ( Johnstone & Kanitsaki, 2007) . These statistics not only demonstrate our mulitculturalism but demonstrates that we are the most culturally diverse society in the world. However, currently the multicultural community of Australia receives health care that does not celebrate ethnicity and therefore may not response sufficiently to their needs. Our health professionals are not ‘culturally clued-in’ to multicultural Australian’s needs and a pertinent example of this the way health care professionals deal with death and dying. There is a considerable public health issue facing Australia as cultural safety is paramount to the delivery of health care to our increasing culturally diverse population. In order for Australia’s health care system to be equitable we must address the needs of our culturally diverse residents, therefore cultural safety must be utilised. Due to Australia’s diverse range of cultures health professionals are likely to care for many culturally diverse patients. Australian health professionals must adapt to changing values and beliefs in order to provide equal, safe and effective care to the population it serves (Omeri, 2008). The acknowledgement of the influence of differing cultures on provision of health care in Australia has long been recognised. During the 1990’s there was a transition from merely the promotion of multiculturalism to a more concerted effort towards integration and the recognition of the impact cultural diversity has on healthcare (De & Richardson, 2008). Currently, there is a mix of strategies that health profession employ in order to address culturally diverse care in Australia (Kanitsaki & Johnstone, 2007). These include the complete omission of recognition of cultural factors and viewing the patient subjectively. The ethos of this strategy is that everyone is the same and should be treated the same ( Okougha, 2010 ) . This seeming equality means that no cultural factors are taken into consideration of care and that all Australians receive a carbon-copy standard of care. Another includes the learning of cultural characteristics of recognised groups and applying this often stereotypical information to patients and results in the often offensive and ineffective provision of care. These approaches both result in a sub-par delivery of health care, De & Richardson (2008) state that in health care cultural factors are broadly acknowledged to be a vital aspect of therapeutic relations. Cultural safety is widely supported by health care experts as the most appropriate and efficient way to work within a highly diverse community (De & Richardson, 2008; Grant, 2005). Cultural safety is defined as “an environment which is safe for people; where there is no assault, challenge or denial of their identity, of who they are and what they need” ( Kanitsaki & Johnstone, 2007). Cultural safety was first developed by New Zealand nurses to address the discrepancies in health outcomes for Indigenous Maoris ( Kanitsaki & Johnstone, 2007). Further, this relates to identifying the expectations and care needs of culturally diverse patients with health professionals considering their own cultural value systems ( Chenowethm; Jeon; Burke, 2006) .  Cultural safety has since evolved to include all those of differing racial, ethnocultural and social backgrounds (De & Richardson, 2008) and has become increasingly regarded as ‘an essential component of accessible, responsive, and high quality health care’ <span class="citationauthor" style="font-family: 'Times New Roman','serif'; font-size: 16px;">(Kanitsaki & Johnstone, <span class="citationdate" style="font-family: 'Times New Roman','serif'; font-size: 16px;">2007; De & Richardson, 2008). Due to the effectiveness of this strategy many countries around the world have since adopted it. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> Cultural Safety is crucial to the provision of high quality health care to all Australian residents as we are one of the most culturally diverse nations in the world. As of 2006 Australia consisted of over 1.2 million Asian residents, 251 000 people from Afric and the Middle East and 192 00 Sub-Saharan Africans (Australian Government: DFAT, 2008). These figures are also demonstrated in data collected from the 2006 census; Hinduism, Islam and Buddhism were the fastest growing religions in Australia. These residents of Australia are entitled to the same level of health care given to Anglo Australians and this can only be achieved through the utilisation of cultural safety by health care professionals. However, studies have shown that Australia is yet to embrace this movement in a manner comparable to Europe, USA, Canada and New Zealand and it is unclear when and to what extent it will do so (Kanitsaki & Johnstone, 2007). <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Through an in-depth study conducted by Kanitsaki & Johnstone (2007) this lack of cultural safety was further analysed. Participants included a wide range of health professionals who were interviewed about cultural safety and its application to health care. Shockingly, most participants interviewed had not heard of the concept of cultural safety. Many commented on experiences where they personally felt that the failure to approach a patient or family in a culturally appropriate manner resulted in poor care and communication. It was also noted that many of these health professionals displayed a ‘lack of openness and acceptance of other cultures’ (Kanitsaki & Johnstone, 2007). The effects of this lacking cultural safety are particularly pertinent to dealing with death, dying and bereavement of culturally diverse patients. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Culture has a significant effect on the way a person conceptualizes death and impacts a broad range of aspects that relate to the death of a human being (Gire, 2002). These different conceptions have a noticeable influence on people’s expression of grief and mourning, and the nature of funeral rituals (Gire, 2002). Each culture has very specific ritual and customs that relate to the dying and the dead. Though these customs may seem absurd or irrelevant to a health professional of western culture, these customs are often very significant and hold the most importance (Gire, 2002). It is important for all health professions to utilise cultural safety when dealing with multicultural patients, particularly when dealing with death. This is the only way to offer these Australians the same level and quality of care as others. The service user will judge whether the professional relationship feels culturally safe (De & Richardson, 2008). <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Australian is a multi-cultural nation and we pride ourselves on this fact; however there is a strong consensus from health professionals that the gains made in the area of multicultural health care over the past 30 years are extremely vulnerable ( <span style="font-family: 'Times New Roman','serif';">Bardi, 2011) <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">. The main reason for this was that culturally appropriate services had not been embedded in the dominant culture (Bardi, 2011; Okougha, 2010 <span style="font-family: 'Times New Roman','serif';">). <span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> It was also stated that in order to succeed it imperative that the issue of culturally safe health care be kept visible in the public arena and for the government, ethnic communities and health care professionals to all take an active role (Kanitsaki & Johnstone, 2007). **<span style="font-family: 'Times New Roman','serif'; font-size: 21.3333px;">Cultural and Social Analysis ** <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Cultural safety as discussed previously is vital for the Australia health care system to be fair, equal and deliver a high quality of service to all Australians regardless of cultural identity. Cultural safety is unique in the fact that it is not the medial memorization of aspects of other cultures but further develops on cultural competence. It relies on the health professional’s development and recognition of their own cultural identity and the acknowledgement of the significance of another’s cultural identity (Kanitsaki & Johnstone, 2007; <span style="font-family: 'Times New Roman','serif';">Chenowethm et al, 2006). <span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> Through the recognition of personal cultural identity a health professional can identify their own cultural assumptions and prejudices. This allows for the development of awareness about how these affect the given situation and what measure need to be taken to provide the highest quality of care possible. Simultaneously the cultural identities of our multicultural residents are why we need to approach health care with cultural safety as these identities influence all aspects of lives and this is seen in the way people deal with health and health care (Usbourne, 2010). <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Cultural identity is an individual’s formation of an identity which is influenced by the belonging to or involvement in a group or culture (Usborne, 2010). It is acknowledged that someone with a clear cultural identity would intuitively know the values, norms and behaviour endorsed by their cultural group (Usbourne, 2010; Amian, 2010). The attachment and commitment to one’s cultural identity has been found to be a key component of cultural identity formation. However according to a recent developmental model, commitment does not solely define a confident, mature, achieved identity (Amian, 2010). It has been suggested that the formation of a cultural identity may result from identification with one’s parent or other role models that have been internalized by the individual (Amian, 2010). This is important in an Australian context as a such a multicultural country, this demonstrates that cultural identities span further than those of differing nationalities, strong cultural identities can be formed from parental and other role models. This means that Australian born people with culturally diverse parents also develop specific and influential cultural identities. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Due to Australia’s multicultural society there are significant numbers of diverse cultural identities that continually interact with one another. One’s cultural identity is not immediately recognisable, however Amian (2010) argues that cultural identities affect the very nature of one’s self-construact and also affects many psychological processes. Usbourne (2010) also states that a cultural identity provides an individual with a clear prototype with which necessary psychological processes are performed. However, we must be made aware that though someone may not act differently to you, they may still have a very different active cultural identity. Amian (2010) states that cultural identities are internal structures that can exist without behaviour. Cultural identities are one of the most important aspects in an individual’s sense of self, imposing on all of us in varying degrees (Amian, 2010). Due to these cultural identities and its effect on human interactions affects us all. However, in the context of health care those of minority ethnic groups are most affected by the misunderstanding and significance of their cultural identity and how this relates to their perceptions of health care. Health professions need to be aware of the influence cultural identities hold and be aware that we also have strong cultural identities that influence our beliefs, assumptions and often actions.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 21.3333px;">Cultural Artefact **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 21.3333px;">Public Health Issue **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 21.3333px;">Literature Review **

**<span style="font-family: 'Times New Roman','serif'; font-size: 21.3333px;">Analysis of Artefact and Reflection ** <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The artefact that I selected to represent my topic is of an Islamic and Jewish gravesite in the cemetery near my house. This is a good ‘case in point’ as it represents the cultural diverse society of Australia. Within an Australian cemetery, no more than fifty metres away from an Australian soldier’s grave are graves of two very culturally different Australians, not separated but inclusive. These graves also represent the cultural identities of the deceased. The Islamic grave is adorned with the Islamic flag motif, with Arabic passages inscribed on the headstone. The Jewish graves are adorned with the Star of David and all mirror each other. These graves illustrated that it is often most obvious in death that culture plays the most important as it can be paramount in overcoming bereavement and grief. Within the cemetery many Anglo-Saxon graves also showed signs of their cultural identity, many had crucifixes, bibles and particular candle and flower placements. These graves demonstrated that cultural identities enter into every aspect of our lives and is emphasised during the death of a human being. This illustrates the power of a cultural identity and the awareness and respect that should be given to it. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">As a result of this assessment piece I have learnt the importance of cultural safety and the power of cultural identities within Australian. As a student in the health care arena I have become much more aware, that in a multicultural society I will encounter many people who are cultural different from me and I know recognising this has the potential to alter a situation. I am also now aware that as an Australian woman, I too have a strong cultural identity that affects the way I look at the world. I believe that now I will recognise cultural difference and am able to approach situations with cultural safety in the health care context.

**<span style="font-family: 'Times New Roman','serif'; font-size: 21.3333px;">References ** <span style="font-family: 'Times New Roman','serif';">Amián, J <span class="citationdate" style="font-family: 'Times New Roman','serif';">(2010) <span style="font-family: 'Times New Roman','serif';">. L <span class="citationarticleorsectiontitle" style="font-family: 'Times New Roman','serif';">iteracy and the formation of cultural identity. <span class="citationsource" style="font-family: 'Times New Roman','serif';">Theory & Psychology <span style="font-family: 'Times New Roman','serif';">, <span class="citationvolume" style="font-family: 'Times New Roman','serif';">20 <span class="citationissue" style="font-family: 'Times New Roman','serif';">(2) <span style="font-family: 'Times New Roman','serif';">, <span class="citationspagevalue" style="font-family: 'Times New Roman','serif';">231-242. Retreived from [] <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Australian Government: Department of Foreign Affairs and Trade (2008). Australia in brief: a diverse people. Retrieved from [] <span style="font-family: 'Times New Roman','serif';">Bardi, A <span class="citationdate" style="font-family: 'Times New Roman','serif';">(2011) <span style="font-family: 'Times New Roman','serif';">. <span class="citationarticleorsectiontitle" style="font-family: 'Times New Roman','serif';">Cultural values predict coping using culture as an individual difference variable in multicultural samples. <span class="citationsource" style="font-family: 'Times New Roman','serif';">//Journal of Cross-cultural Psychology// <span style="font-family: 'Times New Roman','serif';"> //, 42 (6) ,// <span class="citationspagelabel" style="font-family: 'Times New Roman','serif';"> 908-928. Retrieved from <span style="font-family: 'Times New Roman','serif';">[] <span style="font-family: 'Times New Roman','serif';">Chenowethm, L., Jeon, Y. & Burke, C. <span class="citationdate" style="font-family: 'Times New Roman','serif';">(2006) <span style="font-family: 'Times New Roman','serif';">. <span class="citationarticleorsectiontitle" style="font-family: 'Times New Roman','serif';">Cultural competency and nursing care: an Australian perspective. <span class="citationsource" style="font-family: 'Times New Roman','serif';">//International Nursing Review// <span style="font-family: 'Times New Roman','serif';"> //, 53 (1 // <span class="citationissue" style="font-family: 'Times New Roman','serif';">) <span style="font-family: 'Times New Roman','serif';">, <span class="citationspagelabel" style="font-family: 'Times New Roman','serif';"> 34-42. Retrieved from <span style="font-family: 'Times New Roman','serif';">[|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=059e8323-a032-4042-bd7c-255bca75836f%40sessionmgr114&vid=1&hid=127&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2009128639] <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">De, & Richardson, J. (2008). Cultural safety: an introduction. //Paediatric Nursing. 20(2)//, 39-43. Retrieved from [|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=890aade6-e5ed-4fad-9034-7c46c696eb1c%40sessionmgr112&vid=1&hid=127&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2009854586] Gire, J (2002). How death imitates life: cultural influences on conceptions of death and dying. //Psychology and Culture, Unit 3. Retrieved from//. Retrieved from [] <span style="font-family: 'Times New Roman','serif';">Grant, J <span class="citationdate" style="font-family: 'Times New Roman','serif';">(2005) <span style="font-family: 'Times New Roman','serif';">. <span class="citationarticleorsectiontitle" style="font-family: 'Times New Roman','serif';">Culture, communication and child health. <span class="citationsource" style="font-family: 'Times New Roman','serif';">Contemporary Nurse : A Journal for the Australian Nursing Profession <span style="font-family: 'Times New Roman','serif';">, <span class="citationvolume" style="font-family: 'Times New Roman','serif';">20 <span class="citationissue" style="font-family: 'Times New Roman','serif';">(2) <span style="font-family: 'Times New Roman','serif';">, <span class="citationspagelabel" style="font-family: 'Times New Roman','serif';"> 134-142. Retrieved from <span style="font-family: 'Times New Roman','serif';">[] <span style="font-family: 'Times New Roman','serif';">Kanitsaki, O & Johnstone, M <span class="citationdate" style="font-family: 'Times New Roman','serif';">(2007) <span style="font-family: 'Times New Roman','serif';">. Health care provider and consumer understandings of cultural safety and cultural competency in health care: and Australian study <span class="citationarticleorsectiontitle" style="font-family: 'Times New Roman','serif';">. <span class="citationsource" style="font-family: 'Times New Roman','serif';">Journal of Cultural Diversity <span style="font-family: 'Times New Roman','serif';">, <span class="citationvolume" style="font-family: 'Times New Roman','serif';">14 <span class="citationissue" style="font-family: 'Times New Roman','serif';">(2) <span style="font-family: 'Times New Roman','serif';">, <span class="citationspagelabel" style="font-family: 'Times New Roman','serif';"> 96-102. Retrieved from <span style="font-family: 'Times New Roman','serif';">[|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=766deec7-3a1e-4662-a662-fc70cca349ec%40sessionmgr115&vid=1&hid=127&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2009653731] <span style="font-family: 'Times New Roman','serif';">Okougha, M <span class="citationdate" style="font-family: 'Times New Roman','serif';">(2010) <span style="font-family: 'Times New Roman','serif';">. <span class="citationarticleorsectiontitle" style="font-family: 'Times New Roman','serif';">Experience of overseas nurses: the potential for misunderstanding. <span class="citationsource" style="font-family: 'Times New Roman','serif';">British Journal of Nursing <span style="font-family: 'Times New Roman','serif';">, <span class="citationvolume" style="font-family: 'Times New Roman','serif';">19 <span class="citationissue" style="font-family: 'Times New Roman','serif';">(2) <span style="font-family: 'Times New Roman','serif';">, <span class="citationspagelabel" style="font-family: 'Times New Roman','serif';"> 102-106. Retrieved from <span style="font-family: 'Times New Roman','serif';">[|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=7d6f7240-acba-4c56-9c09-50665690f764%40sessionmgr113&vid=1&hid=127&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2010544301] <span style="font-family: 'Times New Roman','serif';">Omeri, A <span class="citationdate" style="font-family: 'Times New Roman','serif';">(2008) <span style="font-family: 'Times New Roman','serif';">. <span class="citationarticleorsectiontitle" style="font-family: 'Times New Roman','serif';">Pathways of cultural awareness. <span class="citationsource" style="font-family: 'Times New Roman','serif';">//Contemporary Nurse : Journal for the Australian Nursing Profession// <span style="font-family: 'Times New Roman','serif';"> //, 28 (2) ,// <span class="citationspagelabel" style="font-family: 'Times New Roman','serif';">p. <span class="citationspagevalue" style="font-family: 'Times New Roman','serif';">3-7. Retrieved from <span style="font-family: 'Times New Roman','serif';">[] <span style="font-family: 'Times New Roman','serif';">Usborne, E <span class="citationdate" style="font-family: 'Times New Roman','serif';">(2010) <span style="font-family: 'Times New Roman','serif';">. <span class="citationarticleorsectiontitle" style="font-family: 'Times New Roman','serif';">The role of cultural identity clarity for self-concept clarity, self-esteem, and subjective well-being. <span class="citationsource" style="font-family: 'Times New Roman','serif';">Personality & Social Psychology Bulletin <span style="font-family: 'Times New Roman','serif';">, <span class="citationvolume" style="font-family: 'Times New Roman','serif';">36 <span class="citationissue" style="font-family: 'Times New Roman','serif';">(7) <span style="font-family: 'Times New Roman','serif';">, <span class="citationspagevalue" style="font-family: 'Times New Roman','serif';">883 <span style="font-family: 'Times New Roman','serif';">-899. Doi: <span class="slug-doi" style="font-family: 'Times New Roman','serif';">10.1177/0146167210372215

=**<span class="slug-doi" style="font-family: 'Times New Roman','serif';">Reflections **=

Reflection 1-

http://healthculturesociety.wikispaces.com/message/view/Stigma+and+Mental+Illness+-+The+Double+Whammy/45702596

Reflection 2-

http://healthculturesociety.wikispaces.com/message/view/Drinks+and+Gen+Y%3F+-+Bloody+Idiots/45702832