Abstract
This research frames the appropriation of Cultural Safety from an indigenous-led bicultural framework to a more inclusive cross-cultural framework for working with diverse patient populations. While scholars have questioned the appropriateness of Cultural Safety models outside an indigenous context, the perceived incompatibility of Cultural Safety alongside other cross-cultural frameworks has seen Cultural Safety continually expand its remit. Consequently, the 2011 Guidelines for Cultural Safety, the Treaty of Waitangi and Maori Health in nursing, education and practice reflect conflicting theoretical ambitions that hinder a clear purpose and effective teaching pedagogies. A mixed-methods survey consisting of both closed and open-ended questions investigates nurses’ understanding of these guidelines, their confidence in meeting them and their relevance. The findings suggest that employing Cultural Safety as an inclusive cross-cultural framework is challenged in three ways. First, data suggests Internationally Qualified Nurses (IQNs) and New Zealand Qualified Nurses are not equally understanding and meeting these guidelines. IQNs who have received Cultural Safety training demonstrated a poorer understanding of the guidelines and less confidence in meeting them than their New Zealand Qualified (NZQN) counterparts. Second, diversifying patient and nurse populations are challenging the idea that self-awareness and an understanding of power relations enable ‘culturally safe care in any context’. Language barriers and the increasing and necessary presence of language interpreters are just two unconsidered obstacles in providing culturally safe care. Third, nurses perceive culture-specific knowledge as essential in meeting the needs of a diversifying patient population. This demand is unmet by Cultural Safety which cautions that this approach can undermine efforts to recognize individual difference and interrogate power relations. This study has four recommendations. First, to ensure all nurses have a critical understanding of power relation and self-awareness, it is recommended that nursing curricula incorporate these discussions outside a cross-cultural context. Consideration of power relations and self-awareness is in fact critical in all patient/provider interactions. Second, to strengthen the purpose and utility of Cultural Safety, Cultural Safety ought to be realigned with ‘for Maori by Maori’ discourses. Third, Registered Nurse Competencies (2012) warrant consideration in light of a diversifying patient and nursing population. Finally, Internationally Qualified Nurses need access to Cultural Safety education that acknowledges their own culture and diversity of learning styles. The findings and recommendations within this study suggest there is potential to better meet the needs of a diversifying patient and nursing populations while upholding the critical role of Cultural Safety within New Zealand.