Cultural safety - a definition

Cultural safety is measured by the sense of safety and comfort of kaumātua and whānau using health services. When kaumātua and whānau feel safe and cared for by the service, whether because of its general approach, or because of the individual health professionals delivering care, then cultural safety has been achieved. Although it is important for health and social care professionals to have reflexive practice, and to know, and be comfortable with their own identity, values, beliefs and cultural customs as well as have an understanding and appreciation of Māori cultural values, beliefs and cultural customs, it is also important that they reflect upon their own assumptions, stereotypes and biases concerning Māori.

Curtis et. al. (2019) provide the following definition of cultural safety:

Cultural safety requires healthcare professionals and their associated healthcare organisations to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery. This requires individual healthcare professionals and healthcare organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities, and as measured through progress towards acheiveing [sic] health equity. Cultural safety requires healthcare professionals and their associated healthcare organisations to influence healthcare to reduce bias and achieve equity within the workforce and working environment.

Furthermore, Curtis et.al. (2019) provide recommendations for organisations to implement cultural safety:

• It is clear from reviewing the current evidence associated with cultural competency and cultural safety that a shift in approach is required. We recommend an approach to cultural safety that encompasses the following core principles:
• Be clearly focused on achieving health equity, with measurable progress towards this endpoint;
• Be centred on clarified concepts of cultural safety and critical consciousness rather than narrow based notions of cultural competency;
• Be focused on the application of cultural safety within a healthcare systemic/organizational context in addition to the individual health provider-patient interface;
• Focus on cultural safety activities that extend beyond acquiring knowledge about ‘other cultures’ and developing appropriate skills and attitudes and move to interventions that acknowledge and address biases and stereotypes;
• Promote the framing of cultural safety as requiring a focus on power relationships and inequities within health care interactions that reflect historical and social dynamics.
• Not be limited to formal training curricula but be aligned across all training/practice environments, systems, structures, and policies.

Cultural safety guidelines can be located in the cultural policy at hospitals, hospices and residential care facilities. There are also Māori health models available that contain information about holistic health care (see below). If you are unsure about what cultural support a family needs from you, ask them. Whānau are normally happy to guide health professionals when they show a sincere willingness to want to get things right. Being humble and saying that you are unfamiliar with cultural protocols but would like to understand what is important for that whānau manaaki shows sincerity and humbleness.

Furthermore, Māori health and social care professionals can be a supportive ally for non-Māori staff who are unfamiliar with some population groups. Ensuring every kaumātua and their whānau feels culturally safe when receiving palliative care may require health and social care professionals to step out of their comfort zones, however having good cultural support (support of Māori colleagues) is essential, especially when trying to support the needs of diverse whānau.