Being Culturally Competent - Cultural Safety and Cultural Responsiveness. A
brief synoptic review of the literature.
Prepared by the Cultural Working Group, Occupational Therapy Mental Health and
Addictions Services, Waikato Hospital, Waikato DHB.
Date: May, 2011
Purpose:
This resource is intended for occupational therapists or other practioners who would
like to increase their understandings of culture and build skills towards cultural
responsiveness.
How to use:
Read this document
Read selected articles and answer questions related to this
Use of cultural self audit
Culture is a significant part of our lives, and some would say the most significant part,
perhaps alongside religion or spiritual beliefs. As health professionals, occupational
therapists value culture as an integral part of a person’s life, or being at the heart of
living well as a community. Culture, as a term, has a broader meaning than the oftenassumed one of pertaining to a specific ethnic group. Cultural competency has its own
legal and professional practice implications for occupational therapists, and this is
assessed, and can be judged, by our governing professional body in Aotearoa/New
Zealand, The Occupational Therapy Board of New Zealand (OTBNZ). There is a lot
of published literature about being culturally competent, but it could be said that there
is limited published literature about occupational therapy and cultural competency,
and assessing cultural competency in occupational therapists.i
Culture has been defined, over the years, by many authors.
“Culture is this system of signification, this fabric of meaning through which
individuals make sense of and interpret their experience and which individuals
must use as a means of guiding their actions with each other, and with the non-human
environment.”ii
“Culture is profoundly and inextricably tied to matters of health and healthcare.
People learn from their own cultures how to be healthy, how to define illness, what to
do to get better and when and from whom to seek help. Culture permeates every
clinical encounter in occupational therapy. The practitioner and the person seeking
care each bring their own personal and familial cultures, whereas the context where
care is provided adds yet another layer of culture.”iii
Therefore culture is embedded within all aspects of activity and occupation. Being
receptive to a client’s world view or culture will increase compliance with
occupational therapy interventions.
The OTBNZ CCFR (Continuing Competence Framework for Recertification) is the
Aotearoa/New Zealand mandatory process for an occupational therapist to
demonstrate their maintenance of ‘good’ professional practice and competence, and
1
this includes demonstrating cultural competency or cultural safety in practice. This is
a self-assessment process, but can and will be assessed by the OTBNZ through its
routine audits of occupational therapists.
“Under the Health Practitioners Competence Assurance Act 2003 (HPCAA), the
OTBNZ is responsible for setting standards of clinical competence, cultural
competence, and ethical conduct. The OTBNZ has set seven competencies for
registration, which are explained in the OTBNZ document Competencies for
Registration as an Occupational Therapist. Competence 3 relates to cultural
competence. However, components of culturally safe practice are embedded in other
competence areas (for example Competency 4 – Communication).”iv
Safe cultural practice has had recognition in our literaturev, and in Aotearoa/New
Zealandvi, as an important issue. The OTBNZ makes this statement about safe cultural
practice:
“Culturally safe practice includes consideration not just of ethnicity, but also
dimensions such as gender, spirituality, sexual orientation, ability, life stage,
language, socio-economics and the experience of trauma (all of which influence
people’s values, beliefs, experiences, and activities).”vii
Another author makes this statement about the term ‘cultural safety’.
“In essence, it is about positive attitudinal change towards those who are culturally
different from ourselves and learning about power relationships between health
professionals and clients. In turn, this attitudinal change and learning is intended to
enable occupational therapists to offer a more appropriate and effective service to
clients from diverse cultures. When viewed this way, Cultural Safety has a scope that
can lead to it being useful for all client/health professional relationships, regardless
of ethnicityviii.”
Assessing cultural competence has been reported as being problematic for health
professionals, including occupational therapists.
“There is no universally accepted definition of cultural competence…model
development in the area of cultural competency is in its infancy in the occupational
therapy profession.”ix
The OTBNZ, however, makes this statement about cultural competence.
“Cultural competence consists of both culture-specific skills and knowledge, and
more generic attitudes, beliefs, values, experience, and approaches to perceived
difference; awareness of the potential impact of these on practice; and skills which
equip a practitioner to work effectively with people who may come from different
cultural contexts.”x
And the OTBNZ goes further to state how the assessment of cultural competence, of a
practitioner, can be achieved.
2
“To practise effectively as an occupational therapist in Aotearoa/New Zealand
requires not only a capacity and preparedness to work with people whose life
experiences and culture may be different from your own, but also to integrate the
principles of te Tiriti o Waitangi/the Treaty of Waitangi into practice. When
considering cultural competence, practitioners should include evaluation of their own
attitudes and beliefs; knowledge of other cultural worldviews and practices; and the
range of culturally appropriate strategies at their disposal, including the allimportant interpersonal ones, in relation to all the dimensions of culture noted
above.”xi
When evaluating cultural competence practioners should:
(i)
(ii)
evaluation of their own attitudes and beliefs
acknowledge of other cultural worldviews and practices
The need to develop our cultural skills over a lifetime, work reflectively and
insightfully to achieve or maintain one’s skill in being culturally competent is
recognised by some authors as arduous, but vital in order to be a ‘safe’ and effective
occupational therapist.xii One author recognizes that the term ‘cultural safety’ has its
origins in a uniquely New Zealand/Aotearoan context.xiii Yet another authorxiv
postulates that cultural competence may not be practical, and another term, cultural
responsiveness, may be more helpful.
So where do we start when doing our best to practice in a culturally safe, or a
culturally responsive way, in order to be sure that we are culturally competent to
practice? Given that we are likely to encounter a diversity of cultures in our daily
practice, and when we are situated in a historically, legally, ethically, and morally
specific cultural context in Aotearoa/New Zealand. Well, this group suggests that
there are a range of tasks that may assist an occupational therapist to strive towards
cultural competency, or cultural responsiveness in our practice and these include:






3
Reading books, journal articles, and relevant magazines, or media, or
attending courses about culture and about being culturally safe, culturally
competent, or culturally responsive.
Keeping an open mind and a willingness to learn.
Embracing others’ cultures, or worldviews.
Reflecting on your strengths and weaknesses in terms of cultural safety,
cultural competency, or cultural responsiveness, as an occupational therapist.
Using supervision, NZAOT Values exchange, and the CCFR process, through
the OTBNZ, as avenues to reflect on your cultural responsiveness and to plan
your goals towards further developing your cultural competency, and cultural
responsiveness.
Additionally, we have prepared a short reference list that might be a starting
point in your cultural competency/cultural responsiveness journey that you can
refer to, read, and learn from.
Suggested Reading List:
Awaad, T. (2003). Culture, Cultural Competency and Psychosocial Occupational
Therapy: A Middle Eastern Perspective. British Journal of Occupational Therapy,
Vol 66 (9), Sep, 409-413.
Gray M, McPherson K. (2005). Cultural safety and professional practice in
occupational therapy: a New Zealand perspective. Australian Occupational Therapy
Journal, Mar; 52 (1): 34-42.
Iwama, M.K. (2007). Embracing diversity: Explaining the cultural dimensions of our
occupational therapeutic selves. New Zealand Journal of Occupational Therapy,
54(2), 16-23.
Iwama, M.K. (2006). Kawa Model. Culturally Relevant Occupational Therapy.
Edinburgh: Churchill Livingstone-Elsevier Press.
Iwama, M.K., Thomson, N.A., MacDonald, R.M. (2009). The Kawa model: The
power of culturally responsive occupational therapy. Disability and Rehabilitation,
31(14): 1125–1135.
Jeffery, H. (2005). Culture clash: a discussion of the provision of mental health
services for Maori consumers in New Zealand. New Zealand Journal of Occupational
Therapy, Sep; 52 (2), 15-21.
Jungerson K. (1992). Culture, theory and the practice of occupational therapy in New
Zealand/Aotearoa. American Journal of Occupational Therapy, 46: 745-750.
Kinebanian, A., Stomph, M. (2010). Diversity matters: guiding principles on diversity
and culture. WFOT Bulletin, Vol 61, May, 5-13.
King, M. (2003). The Penguin History of New Zealand. NZ: Penguin Books.
Kronenberg, F., Algado, SA., Pollard, N. (Eds) (2005). Occupational therapy without
borders – learning from the spirit of survivors. Edinburgh: Elsevier.
Muñoz, J.P. (2007). Culturally responsive caring in occupational therapy.
Occupational Therapy International, 14 (4): 256-80.
Murden, R., Norman, A., Ross, J., Sturdivant, E., Kedia, M., Shah, S. (2008).
Occupational therapy students’ perceptions of their cultural awareness and
competency. Occupational Therapy International, Vol 15(3), 191-203.
Nelson, A. (2009). Learning from the past, looking to the future: Exploring our
place with Indigenous Australians. Australian Occupational Therapy Journal, 56, 97–
102.
Nelson, A., Allison, H., and Copley, J. (2007). Understanding where we come from:
Occupational therapy with urban Indigenous Australians. Australian Occupational
Therapy Journal, 54, 203–214.
4
Odawara, E. (2005). Cultural Competency in Occupational Therapy: Beyond a CrossCultural View of Practice. American Journal of Occupational Therapy, Vol 59 (3),
May-Jun, 325-334.
OTBNZ. (2011). CCFR, Competence: Cultural competence. Wellington: OTBNZ
website. http://www.otboard.org.nz/Competence/CulturalCompetence.aspx
Ramsden I. (1990). Kawa whakaruruhau – Cultural Safety in Nursing Education in
Aotearoa: Report to the Ministry of Education. Wellington: Ministry of Education.
Stedman, A., Thomas, Y. (2011). Reflecting on our effectiveness: occupational
therapy interventions with indigenous clients. Australian Occupational Therapy
Journal, Feb; 58(1): 43-9.
Thomas, Y., Gray, M., and McGinty, S. (2011). Occupational therapy at the 'cultural
interface': lessons from research with aboriginal and torres strait islander australians.
Australian Occupational Therapy Journal, Feb; 58(1): 11-6.
i
Muñoz, J.P. (2007). Culturally responsive caring in occupational therapy. Occupational Therapy
International, 14 (4): 256-80.
ii
Yeats, M. (1995). Uses and abuses of the culture concept. Occupation, 3, 6–14.
iii
Muñoz, J.P. (2007). Culturally responsive caring in occupational therapy. Occupational Therapy
International, 14 (4): p256.
iv
OTBNZ. (2011). CCFR, Competence: Cultural Competence. Wellington: OTBNZ website.
http://www.otboard.org.nz/Competence/CulturalCompetence.aspx
Ramsden I. (1990). Kawa whakaruruhau – Cultural Safety in Nursing Education in Aotearoa: Report
to the Ministry of Education. Wellington: Ministry of Education. And Jungerson K. Culture, theory and
the practice of occupational therapy in New Zealand/Aotearoa. American Journal of Occupational
Therapy, 1992; 46: 745-750.
v
vi
OTBNZ. (2011). CCFR, Competence: Cultural Competence. Wellington: OTBNZ website.
http://www.otboard.org.nz/Competence/CulturalCompetence.aspx
vii
Ibid
viii
Gray M, McPherson K. (2005). Cultural safety and professional practice in occupational therapy: a
New Zealand perspective. Australian Occupational Therapy Journal, Mar; 52 (1): 34-42.
ix
Muñoz, J.P. (2007). Culturally responsive caring in occupational therapy. Occupational Therapy
International, 14 (4): 256-80.
x
OTBNZ. (2011). CCFR, Competence: Cultural Competence. Wellington: OTBNZ website.
http://www.otboard.org.nz/Competence/CulturalCompetence.aspx
xi
xii
Ibid.
Kinebanian, A., Stomph, M. (2010). Diversity matters: guiding principles on diversity and culture.
WFOT Bulletin, Vol 61, May, 5-13.
5
xiii
Gray M, McPherson K. (2005). Cultural safety and professional practice in occupational therapy: a
New Zealand perspective. Australian Occupational Therapy Journal, Mar; 52 (1): 34-42.
xiv
Muñoz, J.P. (2007). Culturally responsive caring in occupational therapy. Occupational Therapy
International, 14 (4): 256-80.
6