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  • Indigenous HealthCommunicationCultural Sensitivity

  • Cross Cultural interactionObstacles to positive interactionCulture shock: health workersCulture Shock: stressorsCultural Shock: indigenous clientsCultural safety

  • Positive Cross-cultural Interaction whenEqual status contact between members of various ethnic groupsContact is between members of majority and higher status members of minority groupWhen authority and/or social climate in favour of an promote the intergroup contactWhen contact of intimate rather than casual natureWhen intergroup contact is pleasant or rewardingWhen members of both groups interact in functionally important activities that are greater in importance than individual goals of each groupHewstone and Brown: Contact and conflict in intergroup encounters, Basil Blackwell, Oxford 1986

  • Obstacles to Positive InteractionStructuralHighly institutionalised health system isolated from issues related to personal, family and community careHistory of colonialism, scientific and institutional racism, legacy of negative legislation, minority anxiety, dependency, mutual stereotypesProfessional structures and demands which overshadow client and caregiver personal needsBiomedical curative rather than holistic health models

  • Obstacles to Positive InteractionIndividual/Personal 1Our perceptions and attitudes to professional role - not just about quality service (Race, creed, religion ARE important)Our perceptions of powerOur perception of and attitude towards change

  • Obstacles to Positive InteractionIndividual/Personal 2Our perceptions and attitudes to professional role - not just about quality service (Race, creed, religion ARE important)Our perceptions of powerOur perception of and attitude towards change

  • Culture Shock: Health WorkersWhen 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 WorkersThe honeymoon phaseShort livedExcitement, fascinationDifferentFriends and colleagues act as buffer, little if any real contact with the culture

  • Culture Shock: Health WorkersThe disenchantment phaseStuck hereThe quaint becomes aggravatingHaving to do things in a different wayAnxiety and inadequacyCompensated for by seeking out fellow countrymen, excluding the indigenous population OR going nativeIf you last, then a chance to take on board different ways of understanding, doing things

  • Culture Shock: Health WorkersBeginning Resolution PhaseSeeking to learn, making friends, becoming participant and observer as much as possibleCharacterised by the return of the sense of humour?Brink and Saunders: Transcultural Nursing: A book of Readings, Prentice Hall, Toronto 1976Increased ability to predict the actions and reactions in situationsAbility to function in more culturally appropriate ways

  • Culture Shock: Health Workersthen the worker may achieve:Effective Function Phaseas comfortable in the new setting as the old. Disadvantage may include reverse culture shock when he goes homeReverse Culture Shock PhaseMay need debriefing. Ideally the worker should become as comfortable in one culture as the other

  • Culture Shock: StressorsCommunicationverbal and nonverbalcomplexity of ideasrules and conventionsacceptable 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)

  • Culture Shock: StressorsMechanical DifferencesThings are different in the bush.Power GasElectricity TelephoneWaterShopsMovies

  • Culture Shock: StressorsIsolationCultural IsolationSocial isolationProfessional isolation

  • Culture Shock: StressorsCustomsDeath: 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 toBirth: born into the community and introduced to it as soon as possibleDisharmony: gossip and shaming help groups control those they think have acted unacceptably. It is an INTERNAL mechanism - stay out of it

  • Culture Shock: StressorsAttitudes and BeliefsHealth Intervention - when reinforced by legislation is not good - compulsory vaccination, chest X-Rays, mantoux testsRespect cherished beliefs. They change far slower in communities than in journalsChanging the message every few years is NOT good practice

  • Culture Shock: Indigenous ClientsIt may seem strange but the issues that affect the health worker also affect the health care recipientChanges 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, anxietyDealing with you in the community or outside it presents them with all the same issues raised so far.CommunicationMechanical DifferencesIsolationCustomsAttitudes and Beliefs

  • Cultural SafetyHealth 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 SafetyCultural 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 SafetyCultural 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 thingsIt must adopt a holistic approach, as must your communicationCommunication is a two way process

  • Cultural Safety - from the communityHealth is the well-being of the whole person - if you feel good in your spirit, thats health - its not just a medical thing. If youve got a good spirit youre 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.

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