Authentic partnership with caregivers of Aboriginal preschool aged children

In the Goldfields region of Western Australia, a research project explored what culturally safe partnerships mean for Aboriginal people and health staff. Using a yarning approach—where connections are built through shared stories—caregivers, Aboriginal community leaders and health professionals reflected on their experiences with Child Health Nurses.

As a health professional in rural and remote Western Australia the impact of life experiences and circumstances on the way people view situations and how they behave is evident. However, it has only been in recent times that peoples’ social circumstances have been coined social determinants of health. Social determinants are now being considered in government documents and are explored in health programs to promote positive outcomes for clients.

The adoption of culturally safe practice in high level documents, including health professional Codes of Practice and Codes of Ethics, is an example of the acknowledgement of the importance of staff working within the clients’ context and perspective to ensure acknowledgement of their social determinants of health.

There was repeated acknowledgement by stakeholders involved in the Goldfields research that many staff expressed a genuine interest in the parents/caregivers, their families and situations (social determinants), but other staff seemed to have a ‘checklist’ approach and were purely focussed on achieving what they were required to do during the consultation. Participants expressed the desire to be ‘heard’ and their concerns acknowledged.

So, what does this mean for the clinician? It is clear to the author that for many staff the concept of culturally safe partnership remains somewhat elusive and mysterious.

Culturally safe practice aligns nicely with authentic partnership. It encourages a reflection on one’s own position and stereotypes and promotes a genuine interest in the perspective of the client. The approach supports improved communication and mutual respect where actions and plans are formed through joint agreement, drawing on the strengths of the client. The role of the health professional is that of a health resource rather than ‘health expert’. 

The quote below by a community leader encompasses the views expressed by some Aboriginal people and health staff alike.

“…I think they (Child Health Nurses) go by textbooks more than anything else. It’s not a relationship with a person, there’s a textbook like, this is how I see you and this is how it’s written, and this is where you fall in, you know, under that category.”  Another quote, this time from a parent, supports this sentiment “...they just want you to go there, get their stuff done, send you on your way, really. As long as they got their needles and everything.”

There are requirements for each consultation and there is no suggestion these should be overlooked, however through open discussion and genuine curiosity about the client’s circumstance and views there can be understanding and agreement around what the parent or caregiver needs and the staff requires.

When staff hold a genuine interest in the client and a curiosity about their life there is a shift away from stereotyping. The quote by an Aboriginal parent “… we all not the same… we all grow up differently.” offers poignant insight around the importance of authentic enquiry and interest in each client. This supports the definition of cultural safety being determined by Aboriginal individuals. The approach acknowledges the variability in culture of modern Aboriginal people.

One Child Health Nurse offered some sage advice when she summarised that a culturally safe approach is “…looking at what the issue or situation looks like from the Aboriginal client’s perspective rather than ours …” The adoption, by staff, of a genuine curiosity into the circumstances and perspectives of the client supports culturally safe partnerships.