Cultural competence is an integral part of the modus operandi of the St. Vincent’s hospital, Melbourne, Australia. It is a territory public healthcare service and provides a range of services that include acute as well surgical facilities, critical care, aged care, rehabilitation, mental health, allied care, and residential care (St. Vincent’s hospital, 2020). The hospital caters to the needs of diverse community that predominantly belong to the catchments if Yarra, Boroondara, Darebin, and Moreland contributing to about 43% of the total patients (St. Vincent’s hospital, 2020). Cultural competence is of essential consideration for the St. Vincent’s hospital as it aims to close the gap of health inequity with the indigenous population.
The hospital recognizes that there a prevailing disparity in the access to healthcare between the indigenous and the aboriginal population. It has been deduced that this disparity largely exists due to lack of competence and prevailing prejudice and stereotyping the healthcare service (Lin et al., 2017). Therefore, it is only possible to “close the gap” between the aboriginal healthcare access is by treating the patients with a person-centered approach and by the development of cultural competence. Through practice of culturally competency in the services, St. Vincent’s hospital assures that essential services are provided to all the citizens without any prejudice and with generous considerations of culture, society, and value for a holistic experience.
Cultural competency has been included as an essential care practice by the code of conduct of the nursing and the Midwifery Board of Australia. The code of conduct establishes that it is an essential duty of ever healthcare worker to preserve the cultural safety of all the workers and ensure that comprehensive care is provided to them free from biases, prejudices and social stigmas (Chamberlain et al., 2019). The St. Vincent’s has developed a guideline for practice of cultural safety and minimization of this gap titled “Aboriginal and Torres Strait Islander Quality Improvement Framework and Toolkit for Hospital Staff” (St. Vincent’s hospital, 2015).
This based on the Cooperative Research Centre for Aboriginal Health (CRCAH) that has strongly supported research focused on “encouraging health institutions to become more receptive and responsive to, and culturally safe for, Aboriginal and Torres Strait Islander people using their services and facilities” (Chamberlain et al., 2019). Through this policy and the work guidelines of the hospital, the following key positions have been included (St. Vincent’s hospital, 2025):
Development of evidence base to find measures that can close the gap between the indigenous population and the mainlanders
Maximizing the participation of the aboriginals in the healthcare facilities
Development of culturally safe care models and promoting its advocacy
Advocation of cultural safety at personal, institutional, and systematic level.
Promotion of cultural literacy by providing knowledge of social determinants of health and to minimize their impact among the indigenous population through collaborative approach.
The St. Vincent’s Hospital therefore resolves to (St. Vincent’s hospital, 2015):
Promotion of culturally safe practices in healthcare
Protection of health rights of the Aboriginal Torres Strait and Islander population.
Promote cultural education and promote participation of the indigenous population in the healthcare sector.
1. Importance of Culturally Safe Health Environment
Culturally safe and competent health environment is essential to provide complete care to the patients. Rapport building is important to enhance communication and build trust among the patients and the carers (Lin et al., 2017) By having a culturally safe environment, conversation between the patient and the carer is encouraged as the patient will feel safe and comfortable. Therefore, culturally safe environment helps in developing strong interrelationships between the healthcare professionals and the patients and hence provides comprehensive care.
Culturally safe environments also help by catering to a large diversity of patients that will feel comfortable in accessing the services. This minimizes the inequity in the sector and helps in development of a stronger health system. It helps in reducing the gap among the groups that may have developed stigma due to prevailing stereotypical behavior and prejudices experienced in past (Henderson et al., 2018). Therefore, culturally safe health environment not only assure comprehensive care to people belonging to all social as well as cultural backgrounds but also advocates for their health right by practicing competence.
2. Role of Effective Communication in Providing Culturally Safe Practice
Communication plays a very crucial role in nursing and healthcare. Linguistic barriers can serve as a major hindrance in perceiving adequate knowledge about the care needs of an individual preventing them from getting adequate services (Young & Guo, 2016). To minimize this, translators are often used in care settings to limit this linguistic barrier and promote effective care. For aboriginals, the liaison officers are also poster in the hospitals that aim to provide complete care to the people belonging to the indigenous population by advocating their needs and helping in communication.
Effective communication is important not only to understand the care needs but also in their effective delivery. When the needs of the patient are nor reciprocated, it may lead to potential harm and may also develop reluctance and reclusive attitude in patients as they may feel that their needs are not being addressed (Henderson et al., 2018). Effective communication helps in providing culturally safe practice as it allows in determination of patient needs, provide them support and develop a feeling of inclusivity.
3. Relationship Between Health Literacy and Communication
Health literacy is defined as an ability of an individual to understand and then act on the health information (Young & Guo, 2020). Health literacy is achieved by effective communication which is considered to be a core foundation if healthcare. Effective communication is linked with patient satisfaction, adherence to the medical recommendations, and overall health outcomes. It is important for the patient to be able to communicate their needs to the healthcare professionals. This helps the healthcare professionals to provide the required care in a comprehensive way for the beneficence of the patient. In case of communication gap, the professional may not be able to properly explain the essential information regarding health problem, medication, or to gather the consent for a procedure. And hence, the overall care is affected. (Heponiemi et al., 2018)
4. Role of External Influences for Practice of Cultural Safety
Cultural safety must be provided to ensure holistic care in a healthcare system. Several external factors that can be either historical or contemporary impact the idea and service of cultural safety. Historically, different cultures and societies may have experiences stigmatization and stereotyping resulting in their seclusion from the mainland community (Jongen et al., 2018). These historical incidences may leave an imprint and affect the overall culture, value, and practiced towards these communities. To limit this discrimination and promote community growth, cultural safety is extremely crucial. Further, cultural safety may also be impacted by the contemporary notions that may arise due to radicalization and various other factors. Media and mass communication agents can therefore help in highlighting the intentional or unintentional prejudice prevailing in the community so that the lacunas can be addressed and holistic care can be provided to individuals belonging to all cultural and social backgrounds (Heponiemi et al., 2018).
5. Role of cultural safety in improving overall health outcomes and target clients
The overall healthy structure is an amalgamation of the healthcare services provided to the entire population, across all communities. Cultural safety ensures that the care needs of the patients are essentially addressed and are met in time. This helps in development of a strong healthcare system where the patient satisfaction is high (Young & Guo, 2020). Cultural safety also ensures person-centered care which is crucial for the sustainment of the healthcare services. Person-centered care prevents the barriers that may arise in provision of care and medical facilities to the patients. Since cultural safety ensures that people from marginalized communities receive the required healthcare, this ensures that the entire spectrum is covered and health problems are avoided.
Cultural safety therefore enhances the overall quality of the healthcare system and provides an inclusive space that can work towards better healthcare of everyone in the community (Heponiemi et al., 2018). It prevents discrimination and prejudice and therefore supports by improving the entire healthcare system. It therefore also helps in getting more clients to the hospital as the place is perceived to be more culturally safe and respectful (Young & Guo, 2020).
6. Barriers in the implementation of cultural safety
Primary barriers that are associated with practice of cultural safety include lack of awareness of differences, lack of adequate training of the nurses. Lack of competence may hinder the application of cultural safety (Holstein, 2019). Further, lack of training of the health professionals can also significantly impact how the cultural safety is practiced in an institution or an organization. Organizational support is therefore also crucial in implementation and working of cultural safety. Inclusive laws and guidelines must be prepared by the institutions that promote cultural competence and assure cultural safety for an inclusive health environment and assure well being of the population as a whole (Holstein, 2019).
Chamberlain, C., Gee, G., Brown, S. J., Atkinson, J., Herrman, H., Gartland, D., ... & Atkinson, C. (2019). Healing the Past by Nurturing the Future—co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study. BMJ Open, 9(6).
Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: a concept analysis. Health & Social Care in the Community, 26(4), 590-603.
Heponiemi, T., Hietapakka, L., Lehtoaro, S., Kaihlanen, A., Wesolowska, K., Aalto, A. M., & Sinervo, T. (2018). Factors associated with cultural competence in health and social care professionals in Finland. European Journal of Public Health, 28(suppl_4), cky213-433.
Holstein, J. (2019). Cultural Competence for Health Professionals: Instrument Development (Vol. 137). Linköping: University Electronic Press.
Jongen, C., McCalman, J., Bainbridge, R., & Clifford, A. (2018). Cultural competence in health: a review of the evidence. Singapore: springer.
Lin, C. J., Lee, C. K., & Huang, M. C. (2017). Cultural competence of healthcare providers: A systematic review of assessment instruments. Journal of Nursing Research, 25(3), 174-186.
St. Vincent’s hospital (2015). Aboriginal and Torres Strait Islander Quality Improvement Framework and Toolkit for Hospital Staff.
St. Vincent’s hospital (2020). Our organization. Retrieved from: https://www.svhm.org.au/about-us
Young, S., & Guo, K. L. (2016). Cultural diversity training: the necessity of cultural competence for health care providers and in nursing practice. The Health Care Manager, 35(2), 94-102.
Young, S., & Guo, K. L. (2020). Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice. The Health Care Manager, 39(2), 100-108.
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