Janine Mahomed, Narrunga Kaurna woman, CEO, Lowitja Institute, former CEO of CATSINaM
When the codes of conduct for nurses and midwives came into effect in March 2018, some media outlets aired wrongful claims that the codes would force white nurses to ‘apologise to Aboriginal and Torres Strait Islander clients for being white’.
Another false claim was that white nurses and midwives would have to announce their ‘white privilege’ before caring for Aboriginal and Torres Strait Islander patients or clients.
Around that time, I rang my dad. We’d hardly begun yarning before he asked me: ‘What’s this about white nurses having to apologise to us for being white?’ I could have just said, ‘Dad, you should know better than to believe what the mainstream media says about us.’
But instead I took the time to explain the truth – because it is important that Aboriginal and Torres Strait Islander people understand how significant these codes are for efforts to improve the care of our people. It’s also important that nurses and midwives know what is really in your codes of conduct about cultural safety and what ‘cultural safety’ means for the care of Aboriginal and Torres Strait Islander patients. An integral part of cultural safety training is that nurses and midwives understand and acknowledge the concept of privilege – in particular, white privilege.
A year or so later, I’m sure that some nurses and midwives would still be hearing disturbing claims or hold mistaken beliefs about your responsibilities around cultural safety.
Let me be clear, nurses and midwives under the codes of conduct do not have to announce their ‘white privilege’ before treating Aboriginal and Torres Strait Islander clients, nor do white nurses and midwives have to apologise for being white. This is a journey of learning and reflective practice.
In developing the codes of conduct, the Nursing and Midwifery Board of Australia (NMBA) listened to the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the organisation for which I was the CEO until 2019. The board also consulted the ANMF, the Australian College of Nursing and the Australian College of Midwives. During this two-year consultation no-one opposed the inclusion of cultural safety into the codes.
Rather than being criticised within sensationalist and inaccurate media reports, the NMBA deserves credit for showing leadership. Cultural safety is not a new concept: in New Zealand, driven by Maori nurses, it was embedded over 10 years ago in the nursing and midwifery code of conduct and the laws that nurses and midwives must follow to be registered.
Credit: Dr Ruth DeSouza, Design: Mitchell Ward @Rocklilydesign
What is in the codes of conduct about cultural safety?
Under the NMBA codes of conduct, nurses and midwives are required to provide care that is ‘holistic, free of bias and racism’, and to recognise the importance of family, community, partnership, and collaboration in the healthcare decision-making of Aboriginal and/or Torres Strait Islander people.
The codes advocate for culturally safe and respectful practice and require nurses and midwives to understand how their own culture, values, attitudes, assumptions, and beliefs influence their interactions with people and families, the community and colleagues.
As part of reflective practice, nurses and midwives are encouraged to consider issues such as white privilege and how this can affect the assumptions and practices they bring to the care of clients and how they interact with families. There has been considerable work over the last 20-30 years to talk about white privilege and address the inequity that many white Australians don’t see or realise is there, but Aboriginal and Torres Strait Islander Australians live with every day. For years we have been talking about male privilege, able-bodied privilege and heterosexual privilege and what is considered ‘normal’. For people living outside the dominant ‘normal’ the world can look very different and as healthcare professionals, we need to think about that.
Racial discrimination (and its intergenerational impact) is well documented as a contributing factor to poor health outcomes for Aboriginal and Torres Strait Islander people, as are the impacts of colonisation. The code of conduct states that understanding and acknowledging historic factors such as colonisation and its impact on Aboriginal and/or Torres Strait Islander people’s health helps inform care.
The health outcomes we are talking about are literally a matter of life and death. After 10 years of attempts to close the gap between Aboriginal and Torres Strait Islander and non-Aboriginal health outcomes, the Closing the Gap Report 2018 says that Aboriginal and Torres Strait Islander mortality rates from cancer – the second leading cause of death – are rising. Aboriginal and Torres Strait Islander males can expect to live 10.6 years less than non-Aboriginal males and Aboriginal and Torres Strait Islander females live 9.5 years less than non-Aboriginal females.
The patient defines safety
A glossary accompanying the new codes, drawn from CATSINaM materials, identifies that the recipient of care – rather than the caregiver – determines whether care is culturally safe. Instead of providing care regardless of difference – such as when people say ‘I treat everyone the same’ – we’re talking about care that takes account of people’s unique needs, including their cultural needs.
While this is important for Aboriginal and Torres Strait Islander clients, it also has the potential to improve all clients’ care by encouraging health practitioners to be more reflexive and responsive to the needs of different clients.
What’s not to like?
There has been widespread support for cultural safety’s implementation across the health system. The National Safety and Quality Health Standards includes a standard in cultural competence in caring for Aboriginal and Torres Strait Islander consumers.
Providing culturally safe care that is free from racism should be a normal expectation. All health professionals learning about cultural safety and building it into their codes of conduct is a very important step to this becoming a reality. Hence nurses and midwives are currently required to study Aboriginal and Torres Strait Islander health, culture, history, and cultural safety as part of their study programs. CATSINaM has developed new teaching and learning materials for the cultural safety core unit of the Diploma of Enrolled Nursing and is developing an online cultural safety training program for nurses and midwives.
It is important that we continue these conversations and embrace cultural safety in practice – it is potentially life-saving.
