Cultural safety is beyond cultural awareness and the acknowledgement of difference.

It
surpasses cultural sensitivity, which recognizes the importance of respecting difference. Cultural
safety is predicted on understanding power differentials inherent in health service delivery and
redressing these inequalities through educational processes (Spence, 2001). Addressing
inequities through the lens of cultural safety, enables care providers, including nurses (Varcoe,
2004), to:

 Improve health care access for patients, aggregates, and populations;

 Acknowledge that we are all bearers of culture;
 Enable practitioners to consider difficult concepts such as racism, discrimination, and
prejudice;
 Acknowledge that cultural safety is determined by those whom nurses provide care;
 Understand the limitation of “culture” in terms of having people access and safely move
through health care systems and encounters with care providers; and
 Challenge unequal power relations
In an article posted by Fran Richardson, he stated that culturally safe care is consistent with caring
qualities inherent in any nursing philosophy. Cultural safety and nursing acknowledge a
connection between the nurse and the person experiencing illness, stress or life changing health
situations. Both aspire to the maintenance and sustenance of health and both value the idea that
the quality of the relationship can influence health care processes and outcomes. Another
feature of cultural safety takes into account the worldview and life experience of the person
receiving care and supports a moral idea of protecting and maintaining human dignity. Culturally
safe care adds another dimension to these shared characteristics by highlighting the role that
power, difference and identity have in shaping health care interactions.
Cultural safety concerns address the adaptability of health care providers especially nurses in
consideration to the fact of having differences in cultural background particularly in language and
communication and dominantly in practices and technology. This is clearly stated in the study
published by Valerie Vestal and Donald D. Kautz; entitled: Responding to Similarities and
Differences between Filipino and American Nurses. According to them, Filipino nurses found that
technology in the hospital differed greatly from that at home. For example, in the Philippines,
blood pressure cuffs are not automated; manual cuffs are still in regular use. Another difference
was the need for nurses to provide personal care to patients in the United States. One nurse said,
"Family in the Philippines help, they feed patients, they are at the bedside 24 hours a day. I've
never seen a patient all alone. When you're sick, someone has to stay in there." The nurse-to-
patient ratio in the Philippines is much higher than in the United States (1:20 or 1:30 in the
Philippines rather than 1:4 or 1:8 in the United States), but registered nurses do not provide
direct care in the Philippines. Families provide all of the care; there are no nursing assistants.
The Filipino nurses noted that the entry level for practice in the Philippines is the Bachelor of
Science in nursing; there are no associate degree in nursing programs. They also noted
differences between patients in the United States and those in the Philippines. They found that
patients in the United States are more demanding and less respectful. One nurse said, "I have
never had a confused patient in the Philippines, unless it is on the psychiatric ward." All of these
differences required adjustments.
This is further supported by Charlene Ronquillo as she described in the result of her study: Leaving
the Philippines: Oral Histories of Nurses’ Transition to Canadian Nursing Practice. According to
her study; the exploration of nursing immigration history in Canada has been analyzed within the
frameworks of gender, identity, and race, in an attempt to understand the experiences of
immigrants. A metasynthesis of the experiences of immigrant Asian nurses working in Western
countries found four overarching themes in the literature: the daunting challenges of
communication; marginalization, discrimination, and exploitation; cultural differences; and
differences in nursing practice (Xu, 2007).
The disconnection between expectations and the reality of working as a nurse overseas is
discussed in several studies (Dicicco-Bloom, 2004; Matiti & Taylor, 2005; McGonagle, Halloran, &
O’Reilly, 2004), which illustrates that the issue is not unique to Filipino immigrants. The narratives
suggest that the autonomy and professional relationships expected of Filipino nurses were often
at odds with their education, training, and nursing experience in the Philippines.
The clear and given fact that people from different places with different experiences and
background should not be divided by these differences by simply integrating safe cultural
practices in order to create a certain bridge between the gap that could possibly hinder the
providence of a sound connection between people most especially in the health care services.
New Zealand nurse and educator Irihapeti Ramsden (Te Awe Awe o Rangitane, Tikao o Ngaitahu)
maintained that cultural safety was not about the patient but about the nurse’s behavior and
attitude towards patients and their ability or otherwise to create a trusting relationship. In the
end; the concern of the cultural safety is to help service providers to adjust and adopt to their
working environment.
References:
Cultural Competence and Cultural Safety in Nursing Education Fjola Hart – Wasekeesikaw RN MN
Leaving the Philippines: Oral Histories of Nurses’ Transition to Canadian Nursing Practice:
Charlene Ronquillo
Guidelines for Cultural Safety, the Treaty of Waitangi and Maori Health in Nursing Education and
Practice Nursing Council of New Zealand 2011
Nursing Review: What is cultural safety and why does it matter? Fran Richardson
Responding to Similarities and Differences Between Filipino and American Nurses Valerie Vestal,
MSN, RN and Donald D. Kautz, RN, PhD, CNRN, CRRN-A