The role of cultural safety in the care of Indigenous Australians

Indigenous Australian’s experience the worst health outcomes in this country and the reasons for this remain complex. For clinicians to manage the health of Aboriginal and Torres Strait Islander people better and to work effectively with them requires a variety of skills including an insight to the impact of racism, historical events and the social determinants of health.

Members of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) are Indigenous nurses and midwives. They often share stories about the strengths that Indigenous Australians have despite the adversity and challenges in their lives.

Cultural safety stems from the work of Maori nurse Irahapeti Ramsden who talked about the importance of clinicians, including nurses and midwives, acknowledging their difference from the patients they care for. This difference means that they need to reflect on how the care they provide can be impacted by their own beliefs and values. Once the clinician can acknowledge this difference, to be culturally safe they need to ask the patient how they feel in the care of that clinician.

For CATSINaM members this means when a patient enters a health care service, they need to feel welcome and safe beginning with their interaction with the person on the front desk, and through to their discharge from the service. This can be difficult when health care services are busy and chaotic, however staff within the service need to acknowledge and respect the patient. This includes giving a welcoming smile or taking time to say hello.

Within the health care service, the patient must feel involved in their care. This may mean they use a spokesperson or someone from their family who knows their medical history to communicate for them. If an Aboriginal and/or Torres Strait Islander person is really unwell often many family members will come to see them. This can be overwhelming for the clinicians, however it is important that the family feel included and supported. Aboriginal and Torres Strait Islander patients and families often complain about feeling neglected or that clinicians are not offering the same care they provide other patients because of stereotypes. Non-Indigenous clinicians may label Aboriginal and Torres Strait Islander patients as non-compliant with treatments or a discharge plan when, in fact, they don’t understand the instructions, or because they said ‘yes’ to get back with their family, or when English is a second language.

A case study
Suzie (*not the patient’s real name) presents to the emergency department complaining of abdominal pain and she is getting aggressive towards the staff; however, she is feeling frustrated because they won’t give her any pain relief. She feels she is being labelled as a ‘drug seeker’ because she was addicted to heroin however, she has been clean for the past four years.

As she becomes more and more agitated security is called and she is about to be restrained when the Aboriginal Liaison Officer (ALO) comes to see her. The ALO talks quietly to Suzie who explains what is happening and why she is getting angry. The ALO advocates for Suzie. The ALO gets Suzie to stop being aggressive so the staff can manage her pain and do the tests required to diagnose her condition.

The ALO educates staff about Suzie and explains that she is worried about money because she has young children at home, and she is the only one with a job to get money to feed the family. The social worker agrees to provide her with some financial support while she is hospital and then Suzie can focus on getting better.