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 DVD NZNO 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 3

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 4

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. 5

e=player_detailpage&v=7jEn1ZYDeH w e=player_detailpage&v=7jEn1ZYDeH w

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 Nurses Are 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 Safety the 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 illness Making a world of difference, Fran Richardson, Kai Tiaki: Nursing NZ (May 2012) 12

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

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), 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