Download - Indigenous Health Communication Cultural Sensitivity Communication Cultural Sensitivity

Indigenous HealthIndigenous Health

CommunicationCultural Sensitivity

CommunicationCultural Sensitivity

Cross Cultural interactionCross Cultural interaction Obstacles to positive interaction

Culture shock: health workers Culture Shock: stressors Cultural Shock: indigenous clients

Cultural safety

Obstacles to positive interaction

Culture shock: health workers Culture Shock: stressors Cultural Shock: indigenous clients

Cultural safety

Positive Cross-cultural Interaction when…Positive Cross-cultural Interaction when… Equal status contact between members of various ethnic groups

Contact is between members of majority and higher status members of minority group

When “authority” and/or social climate in favour of an promote the intergroup contact

When contact of intimate rather than casual nature

When intergroup contact is pleasant or rewarding When members of both groups interact in functionally important activities… that are greater in importance than individual goals of each group

Hewstone and Brown: Contact and conflict in intergroup encounters, Basil Blackwell, Oxford 1986

Equal status contact between members of various ethnic groups

Contact is between members of majority and higher status members of minority group

When “authority” and/or social climate in favour of an promote the intergroup contact

When contact of intimate rather than casual nature

When intergroup contact is pleasant or rewarding When members of both groups interact in functionally important activities… that are greater in importance than individual goals of each group

Hewstone and Brown: Contact and conflict in intergroup encounters, Basil Blackwell, Oxford 1986

Obstacles to Positive InteractionObstacles to Positive Interaction

Structural Highly institutionalised health system

isolated from issues related to personal, family and community care

History of colonialism, scientific and institutional racism, legacy of negative legislation, minority anxiety, dependency, mutual stereotypes

Professional structures and demands which overshadow client and caregiver personal needs

Biomedical “curative” rather than holistic health models

Structural Highly institutionalised health system

isolated from issues related to personal, family and community care

History of colonialism, scientific and institutional racism, legacy of negative legislation, minority anxiety, dependency, mutual stereotypes

Professional structures and demands which overshadow client and caregiver personal needs

Biomedical “curative” rather than holistic health models


Individual/Personal 1 Our perceptions and attitudes to professional role - not just about quality service (Race, creed, religion ARE important)

Our perceptions of power Our perception of and attitude towards change



Culture Shock: Health WorkersCulture Shock: Health Workers “When well established habits no longer

have expected consequences…”(Bochner, S.: Cultures in Contact: Studies in Cross-Cultural Interaction, Pergamon, Sydney 1982

Three phases most people move through, and if they adapt well enough further stages follow.

“When well established habits no longer

have expected consequences…”(Bochner, S.: Cultures in Contact: Studies in Cross-Cultural Interaction, Pergamon, Sydney 1982

Three phases most people move through, and if they adapt well enough further stages follow.

Culture Shock: Health WorkersCulture Shock: Health Workers

The honeymoon phase Short lived Excitement, fascination Different Friends and colleagues act as buffer, little if any real contact with the culture

The honeymoon phase Short lived Excitement, fascination Different Friends and colleagues act as buffer, little if any real contact with the culture


The disenchantment phase “Stuck here” The quaint becomes aggravating Having to do things in a different way Anxiety and inadequacy Compensated for by seeking out fellow countrymen, excluding the indigenous population OR “going native”

If you last, then a chance to take on board different ways of understanding, doing things

The disenchantment phase “Stuck here” The quaint becomes aggravating Having to do things in a different way Anxiety and inadequacy Compensated for by seeking out fellow countrymen, excluding the indigenous population OR “going native”

If you last, then a chance to take on board different ways of understanding, doing things


Beginning Resolution Phase Seeking to learn, making friends, becoming participant and observer as much as possible

Characterised by the return of the sense of humour?Brink and Saunders: Transcultural Nursing: A book of Readings, Prentice Hall, Toronto 1976

Increased ability to predict the actions and reactions in situations

Ability to function in more culturally appropriate ways

Beginning Resolution Phase Seeking to learn, making friends, becoming participant and observer as much as possible

Characterised by the return of the sense of humour?Brink and Saunders: Transcultural Nursing: A book of Readings, Prentice Hall, Toronto 1976

Increased ability to predict the actions and reactions in situations

Ability to function in more culturally appropriate ways


…then the worker may achieve:Effective Function Phase…as comfortable in the new setting as the old. Disadvantage may include reverse culture shock when he goes home

Reverse Culture Shock PhaseMay need debriefing. Ideally the worker should become as comfortable in one culture as the other

…then the worker may achieve:Effective Function Phase…as comfortable in the new setting as the old. Disadvantage may include reverse culture shock when he goes home

Reverse Culture Shock PhaseMay need debriefing. Ideally the worker should become as comfortable in one culture as the other

Culture Shock: StressorsCulture Shock: Stressors

Communication verbal and nonverbal complexity of ideas rules and conventions acceptable behaviour and etiquette

(respect especially to children and the elderly)

Promises and what they mean (sometimes there is the need not to say no, while at the same time not to say yes!)

(I call that Eastern Standard Koori Time)

Communication verbal and nonverbal complexity of ideas rules and conventions acceptable behaviour and etiquette

(respect especially to children and the elderly)

Promises and what they mean (sometimes there is the need not to say no, while at the same time not to say yes!)

(I call that Eastern Standard Koori Time)


Mechanical DifferencesThings are different in the bush. Power Gas Electricity Telephone Water Shops Movies

Mechanical DifferencesThings are different in the bush. Power Gas Electricity Telephone Water Shops Movies


Isolation Cultural Isolation Social isolation Professional isolation

Isolation Cultural Isolation Social isolation Professional isolation


Customs Death: in some cultures the deceased is not mentioned, some they are remembered, some are adamant about returning to their land to die, many attend the funerals “because it would be disrespectful not to”

Birth: born into the community and introduced to it as soon as possible

Disharmony: gossip and shaming help groups control those they think have acted unacceptably. It is an INTERNAL mechanism - stay out of it…

Customs Death: in some cultures the deceased is not mentioned, some they are remembered, some are adamant about returning to their land to die, many attend the funerals “because it would be disrespectful not to”

Birth: born into the community and introduced to it as soon as possible

Disharmony: gossip and shaming help groups control those they think have acted unacceptably. It is an INTERNAL mechanism - stay out of it…


Attitudes and Beliefs Health Intervention - when reinforced by legislation is not good - compulsory vaccination, chest X-Rays, mantoux tests

Respect cherished beliefs. They change far slower in communities than in journals

Changing the message every few years is NOT good practice

Attitudes and Beliefs Health Intervention - when reinforced by legislation is not good - compulsory vaccination, chest X-Rays, mantoux tests

Respect cherished beliefs. They change far slower in communities than in journals

Changing the message every few years is NOT good practice

Culture Shock: Indigenous ClientsCulture Shock: Indigenous Clients

It may seem strange but the issues that affect the health worker also affect the health care recipient

Changes deeply affect the indigenous patient transferred to the big city for surgery - loss of identity, loss of autonomy, alienation, loss of personal space, shame/embarrassment, powerlessness, fear, anxiety

Dealing with you in the community or outside it presents them with all the same issues raised so far. Communication Mechanical Differences Isolation Customs Attitudes and Beliefs

It may seem strange but the issues that affect the health worker also affect the health care recipient

Changes deeply affect the indigenous patient transferred to the big city for surgery - loss of identity, loss of autonomy, alienation, loss of personal space, shame/embarrassment, powerlessness, fear, anxiety

Dealing with you in the community or outside it presents them with all the same issues raised so far. Communication Mechanical Differences Isolation Customs Attitudes and Beliefs

Cultural SafetyCultural Safety

Health workers are aware of the importance of physical, ethical and legal safety in health care, but unaware of or insensitive to the importance of providing culturally safe environment to facilitate physical, ethical and legal safety of the clientsRamsden, Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. A report for the Maori Health and Nursing Ministry of Education, New Zealand, 1990

Health workers are aware of the importance of physical, ethical and legal safety in health care, but unaware of or insensitive to the importance of providing culturally safe environment to facilitate physical, ethical and legal safety of the clientsRamsden, Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. A report for the Maori Health and Nursing Ministry of Education, New Zealand, 1990


Cultural safety, as defined in 1988 by the Hui Waimanawa, Christchurch, requires that:

The validity of [Maori] cultural values be recognised, especially as they relate to their perceptions of health, their tapu, and the holistic nature of their being…

Ramsden, Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. A report for the Maori Health and Nursing Ministry of Education, New Zealand, 1990

Cultural safety, as defined in 1988 by the Hui Waimanawa, Christchurch, requires that:

The validity of [Maori] cultural values be recognised, especially as they relate to their perceptions of health, their tapu, and the holistic nature of their being…

Ramsden, Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. A report for the Maori Health and Nursing Ministry of Education, New Zealand, 1990


Cultural safety then is the need to be recognised within the health care system, and to be assured that the system reflects something of you - of your culture, language, customs, beliefs, attitudes and preferred ways of doing things

It must adopt a holistic approach, as must your communication

Communication is a two way process

Cultural safety then is the need to be recognised within the health care system, and to be assured that the system reflects something of you - of your culture, language, customs, beliefs, attitudes and preferred ways of doing things

It must adopt a holistic approach, as must your communication

Communication is a two way process

Cultural Safety - from the communityCultural Safety - from the community

Health is the well-being of the whole person - if you feel good in your spirit, that’s health - it’s not just a medical thing. If you’ve got a good spirit you’re happy in your heart People have a good spirit when you can have all of your family with you, to know your children are well, to have your child born on your land, to have a job, not to have to worry about where your next feed is coming from, to be where everything is familiar, to feel comfortable, to be free of worries about health problems, to have choice without fear of reprimand - an anxious mind drains a good spirit.

Health is the well-being of the whole person - if you feel good in your spirit, that’s health - it’s not just a medical thing. If you’ve got a good spirit you’re happy in your heart People have a good spirit when you can have all of your family with you, to know your children are well, to have your child born on your land, to have a job, not to have to worry about where your next feed is coming from, to be where everything is familiar, to feel comfortable, to be free of worries about health problems, to have choice without fear of reprimand - an anxious mind drains a good spirit.

Download - Indigenous Health Communication Cultural Sensitivity Communication Cultural Sensitivity

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