'Public health programs [cancer control] should address what is and not what ought to be'.20
An important step in closing the gap in inequities in cancer outcomes for Indigenous people is to improve the cultural safety skills of service providers.
Cultural safety is a concept of care first advocated by the Maori nurses of New Zealand in the late 1980s. Cultural safety is concerned with power relationships between nurses and those in their care. The recipients of nursing care are empowered to decide what is culturally safe rather than complying passively with the authority of nurses or other health professionals.21
The underlying premise of cultural safety is based on a partnership relationship in which the vulnerable 'other' is at liberty to negotiate their nursing care even if that means nurses diverting from usual practice.21 Too often the dominant health system aims to change behaviours and attitudes that are deeply ingrained in the cultural psyche of others.
Cultural safety requires a level of cognitive, attitudinal and personal skills that enhance communication and interaction with others.22 Developing cultural safety is a process rather than an end point.22 It involves personal reflective practice as a means of recognising values inherent in the culture of cancer nursing, and one's own culture, which may conflict with others.
Three steps towards cultural safety
Developing culturally safe practice requires the capacity to make adjustments to services that accommodate culturally different needs. The process of developing cultural safety involves individuals and organisations in three broad steps.23
Step 1: Cultural consciousness or awareness of the constructs of one's own culture and recognition of unique and similar qualities of other cultural groups. Engagement with minority cultural groups is imperative to the process of cultural consciousness and building collaborative cancer control programs.
Step 2: Cultural appraisal or assessment to identify cultural domains of difference that need to be considered in the plan of person-family centred cancer care.
Step 3: Cultural safety skill development of appropriate behaviours, attitudes, and communication strategies that reduce the gap of inequities in cancer outcomes.