www.nzno.org.nz

Julia Anderson

Professional Nursing Adviser

September 2013

Harmless nursing chat or alienating attitudes?

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 DVDNZNO 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

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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

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 Ability for a nurse to recognise a ‘trust

moment’ in the nursing relationship and then be able to build on it.

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https://www.youtube.com/watch?feature=player_detailpage&v=7jEn1ZYDeHw

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:

Timely Safe Ethical Equitable Efficient Effective Patient centred

Expectations By society of NursesAre 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

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 NCNZ (2012) Code of Conduct NCNZ (2012) Professional Boundaries NCNZ (2011) Guidelines for cultural

safety NZNO Code of Ethics (2010)

Cultural Safetythe 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 illnessMaking a world of difference,

Fran Richardson,

Kai Tiaki: Nursing NZ (May 2012)

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NCNZ 2011 – Cultural Safety The effective nursing practice of a person or

family/whanau from another culture, and is determined by that person or whanau.

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

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.

________________________________

In pairs

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

Respect for each other’s points of view

One person talking at a time

Continuum of responses to discriminatory attitudes and feelings

OPPRESSION---------------POSITIVE ACTION

•Participating in discriminatory attitudes

•Denying or ignoring

•Recognition but no action

•Recognising and interrupting

•Educating self

•Questioning and discussing

•Supporting and encouraging change

Identifying strategies to lesson discriminatory attitudes and behaviours

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

How do you respect the rights of all patients?

How do you support a colleague to take action or make a complaint?

Conclusion 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

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

KNOWLEDGE: Acquire a knowledge base of cultures in your service area, especially in relation to healthcare practices and beliefs.

ATTITUDE: Avoid making stereotypical assumptions about your patients' culture; become aware of your own biases and prejudices.

SKILLS: Learn new communication skills to simplify language for any patient, regardless of primary language.

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