Forum debates cultural competence.

STRENGTHENING THE position of cultural safety in nursing, midwifery and health in Aotearoa/New Zealand was the aim of last month's cultural safety forum in Wellington.

Held at Tapu Te Ranga Marae, the forum was hosted by the Wellington cultural safety collective and followed last year's forum at the Western Institute of Technology in Taranaki. At least 80 people were there over the three days, with representation from cultural safety tutors, nurses in practice and students from throughout the country. On the Friday, students from Whitireia Community Polytechnic's new Pacific bachelor of nursing (BN) programme attended, wearing their distinctive uniforms.

First keynote speaker, senior lecturer at Victoria University's Graduate School of Nursing and Midwifery, Rose McEldowney, posed a number of questions to the group, including: Are we making a difference? How do we know? Is cultural safety making a difference to health outcomes? She linked her presentation to her doctoral research in which she interviewed six Pakeha nurse educators committed to teaching for social change.

Massey University (Wellington) senior lecturer in nursing (Maori health), Denise Wilson, began her address by paying her respects to cultural safety architect, the late Irihapeti Ramsden, who died one year ago on April 5. She pointed to the great variation in the way cultural safety education was delivered and assessed, and in the way it was practised by both educators and practitioners. In her research with Maori women, it was clear their call for culturally appropriate and acceptable health services had still to be heard. "Some groups, eg Maori, Pacific and refugee people, are underutilising primary health services and in our education institutions we continue to have difficulty recruiting and retaining Maori and Pacfic students. A paradox is evident in the 'indvidualised' care we teach and claim to deliver, but end up with a 'one-size-fits-all' approach to the delivery of health services. True individualised care that accounts for the beliefs and pactice of clients tends to be an exception rather than a certainty," she said.

Although cultural safety was a core competency of all registered nurses, including educators, Wilson said she had observed examples where individuals and groups of nurses had displayed a disrespect of other's cultural beliefs and practices and disguised substandard practice. Nurses needed to debate and explore a more robust way of measuring whether someone's practice was culturally safe. She recommended the development of the concept of "cultural competence", which would measure individuals' actual performance.

Overseas keynote speaker was journalist and Wirdjuri woman Kath Howey, who has been an adviser and lecturer for Sydney University's new BN, Indigenous Australian Health. The new four-year degree aims to equip graduates, both indigenous and non-indigenous, with particular expertise to work in and with indigenous communities and individuals.

Describing herself as "a black chick from Sydney", Howey said her work writing the cultural awareness programme had taken the nursing faculty "in quite new directions". All nursing undergraduates studied Australian history and indigenous health. However, in the new degree, studies were much more intense. A particular challenge in developing the new curriculum was the fact there had been nothing written about nursing Aboriginal people in Australian nursing literature.

Keynote speaker on the final day was dean of Whitireia Community Polytechnic's faculty of health, education and social sciences Margaret Southwick. She discussed the development of the polytechnic's new Pacific nursing programme and the particular challenges faced by Pacific nurses in the workforce.

A press release put out at the end of the forum affirmed strong support for the fundamental role of the Treaty of Waitangi in New Zealand society, legislation and policy, particularly in light of recent comments by National Party leader Don Brash. it also called on New Zealanders to become better informed about the reasons behind poor health and the effort needed to improve Maori health.