Harmless nursing chat or
alienating attitudes?
Julia Anderson
Professional Nursing Adviser
September 2013
www.nzno.org.nz
Objectives
1. Raise awareness of cultural safety and
discrimination in its varying guises
2. Examine and challenge personal feelings
and attitudes
3. Identify new strategies to positively respond
when witnessing discriminatory attitudes
and behaviours.
4. Encourage greater understanding of
professional nursing practice
About the DVD
NZNO receives many reports and hears many
stories from NZNO members
Concerned, Angered, Hopeless
Developed to stimulate reflection of oppressive
behaviours and attitudes and affect change
Linked programme to concepts from nursing
that address discriminatory attitudes –
cultural safety
3
How it began
Tiriti o Waitangi 1840 – Maori attempts to
maintain rights and recognition
Inequities recognised – lead to
1970/80s – social protest movements –
identity, gender, racism
Challenge of dominant worldview – male
and western
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KAWA WHAKARURHAU –
CULTURAL SAFETY
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NZ owned and proud
INITIALLY – the power health
professionals had in health outcomes
of patients
1988-early 2000 – Irihapeti Ramsden
- embedded c.s. into nursing education
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Ability for a nurse to recognise a ‘trust
moment’ in the nursing relationship and
then be able to build on it.
5
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https://www.youtube.com/watch?featur
e=player_detailpage&v=7jEn1ZYDeH
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Nurses have a legal and
professional
duty to ensure that they
care
for their patients and that the
care
is given to a certain standard
Glover (1999)
Expectations By Society of Health
Professional
Are that healthcare is:
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Timely
Safe
Ethical
Equitable
Efficient
Effective
Patient centred
Expectations By society of Nurses
Are that they are:
 Attentive
 Courteous
 Know what they are doing
 Provide them with correct information,
willingly
 Be focused on them (the Consumer)
 Aware that they are privileged to be able to
care for them
Make their care your first concern.
Pam Doole Nursing Council 2012
Competencies for ENs, RNs, NPs
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All domains direct effective nursing care
Professional responsibility
Management of nursing care
Interpersonal relationships
Interprofessional health care nad quality
improvement
All domains inclusive of cultural safety
Underpinning documents
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NCNZ (2012) Code of Conduct
NCNZ (2012) Professional Boundaries
NCNZ (2011) Guidelines for cultural
safety
NZNO Code of Ethics (2010)
Cultural Safety
the culture of the person receiving the
care
the culture of the nurse and
the culture of the setting within which
nursing happens.
Culturally safe care implies a person
feels protected and in control of who
they are in times of illness
Making a world of difference,
Fran Richardson,
Kai Tiaki: Nursing NZ (May 2012)
12
NCNZ 2011 – Cultural Safety
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The effective nursing practice of a person or
family/whanau from another culture, and is
determined by that person or whanau.
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Culture includes, but is not restricted to, age or
generation, gender, sexual orientation, occupation
and socio-economic status, ethnic origin or migrant
experience, religious or spiritual belief and disability
“As autonomous practitioners,
nurses
are answerable and responsible for
the
outcomes of their professional
actions”.
Glover (1999)
By virtue of having sought recognition
as a professional we have
acknowledged our obligations and
have accepted that we will be
held accountable for what we do,
what we don’t,
and for failing to act when it is expected
that we would have the
knowledge and skill
to act.
Peach J, (2000)
Professional Behaviour - the act of
behaving in a manner defined and expected
by the chosen profession
Nurses are expected to
uphold exemplary standards of conduct.
Nurses have the trust of the
public to undertake their professional role,
they must also have a high
standard
of behaviour in their
personal lives.
NCNZ Code of Conduct (2012)
Professional Behaviour is
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Responsible
Accountable
self-directed
Professional
Nurses are responsible for articulating
nursing values, maintaining the integrity of
the profession, ensuring culturally safe,
competent practice and shaping public
policy.
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In pairs
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Reflect on the responses made?
Were responses effective in
interrupting and/or challenging the
behaviour?
Identify any contextual issues, barriers
or motivating factors to intervening.
Ground Rules
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Respect for each other’s points of view
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One person talking at a time
Continuum of responses to
discriminatory attitudes and feelings
OPPRESSION---------------POSITIVE ACTION
Identifying strategies to lesson
discriminatory attitudes and
behaviours
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Is the discrimination being expressed
by an individual, group or
organisation?
Are there power balances that need to
be considered?
Is it implicit or explicit discrimination?
As a group
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How do you respect the rights of all
patients?
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How do you support a colleague to
take action or make a complaint?
Conclusion
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Take affirmative action when you
identify a situation in which
discriminatory and alienating attitudes
are being expressed
Constructive relationships accept
differences
Express yourself while respecting
others – Assertive Communication
Understand power imbalances
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Work co-operatively and respect the skill,
expertise and contributions of your
colleagues.
Share your skills and experience so that
others benefit
Treat your colleagues and clients fairly and
without discrimination
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KNOWLEDGE: Acquire a knowledge base
of cultures in your service area, especially in
relation to healthcare practices and beliefs.
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ATTITUDE: Avoid making stereotypical
assumptions about your patients' culture;
become aware of your own biases and
prejudices.
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SKILLS: Learn new communication skills to
simplify language for any patient, regardless
of primary language.
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Nursing in Aotearoa New Zealand: A Definition Clendon, J.
(2011). Nursing in Aotearoa New Zealand: a definition.
Background document. Wellington: New Zealand Nurses
Organisation August 2011
Glover D. (1999). Accountability. Nursing Times Clinical
Monographs, 27
Peach. J, (2000) Professional accountability. The Professional
Leader, Vol 4 (2), 18-20.
Nursing Council of NZ – Scope of Practice,
Competencies/Domains of Practice, Code of Conduct, Cultural
Safety Guidelines, Maori Health in Nursing Education and
Practice 2011
NZ Nurses Organisation – Harmless nursing chat or alienating
attitudes, 2012