Cultural safety in nursing education and practice in Aotearoa New Zealand : a thesis submitted in partial fulfilment of the requirements for Doctor of Philosophy, Massey University
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The Nursing Council of New Zealand introduced cultural safety into the nursing education curriculum in 1990. Since that time it has impacted on nursing education and the delivery of nursing and health care in a profound way. There is very little research exploring application of the concept in nursing practice and that is what this thesis explores. Cultural safety has as its central focus, the nurse and the person for whom she or he cares within complex fields of health care relationships. This thesis argues that culturally safe care is open to multiple interpretations depending on the lens through which safety is perceived and care is interpreted, and applied in everyday practice. The narratives of 16 registered nurses suggest that both safety and care relate to an idea of protection carried out in everyday care. During times of illness or threatened change in health, a person’s sense of self and safety, can be vulnerable to professional and institutional practices which may put their sense of identity and well being at risk. The self-conscious provision of culturally safe nursing takes account of the need to protect identity and requires that the nurse have a practical understanding of professional and structural factors influencing health care. This thesis draws on the theoretical work of Pierre Bourdieu (1972, 1984, 1990, 1998, 2000) and Margaret Somers (1994) and focuses on identity, fields of practice, power and reflexivity. These concepts resonate with key organising themes within cultural safety discourses and guided the research process. An abductive research strategy (Blaikie, 2002, 2010) was used to shape and guide the analysis process. The research identifies that culturally safe nursing is not the sole responsibility of the individual nurse and this thesis moves the concept away from a focus on individual nurses and individualised relationships between the nurse and the patient. It extends understanding of cultural safety education and practice by drawing on Bourdieu’s concepts of fields, doxa, and relational networks of power and how these factors shape practice. It examines ways nurses within different health care fields use resources that are available to open up or close down possibilities for them to create the conditions to provide culturally safe care. The thesis identifies how the participants negotiated these contradictions and illustrates how culturally safe care has the potential to aid the demonstration of safe and effective nursing care in all fields of health care.
Patient identity, Nursing, Maori health