Revisiting cultural safety: as NZNO embraces the PAUA project, it is timely to look again at how the concepts of cultural safety can be made real in nursing.

LAST MONTH'S issue of Kai Tiaki Nursing New Zealand provided a snapshot of the unveiling of Irihapeti Ramsden's headstone (p6) and an update of continued discussions for Paua--Progressively Act in Unity and Aroha, (p26). With Matariki (Maori New Year) upon us, it is timely to look to our goals and new year resolutions, and to remember those who have passed on. This article seeks to do both.

At its May meeting the board of directors endorsed Paua, NZNO's strategic treaty-based model, with a commitment to build relationships with Maori, premised on equality, mutual respect and acknowledgement of the right to autonomy.

There is debate regarding the impact of cultural safety in reducing disparities and negative health outcomes in New Zealand. Paua puts NZNO centre stage in promoting the evolution of cultural safety theory into bicultural policy and exploring the dynamic nature of the relationship between nursing leadership and Maori culture.

The Paua focus is on active participation that will assist NZNO to develop Kaupapa Maori into nursing policy. Paua will further contribute to the examination of the outcomes and progression of cultural safety practices within nursing and the larger social community of New Zealand. The potential to improve policy through pragmatic bicultural approaches will assist in balancing efficiency with social justice and must he undertaken.

Recently nurses around the country attended the cultural safety hui at Tapu Te Ranga Marae in Island Bay. A buffet of conversation through workshops and speakers was on offer. As the atmosphere of the hui unfolded, it became clear that there was much that nurses wanted to share about their personal journeys and understandings of cultural safety. I was privileged to be in the company of such depth and richness, which clearly demonstrated the uniqueness of nurses. Professional, passionate and proudly reflecting the underlying purpose of cultural safety in nursing. Nurses united in their aspirations to celebrate diversity and difference. What struck me most about this hui was the abundant goodwill and trust of the participants.

A short time ago I had the honor of reading the cultural safety thesis of Irihapeti Ramsden, who reminds us so articulately in her personal narrative that "the necessity to think differently and to act differently in order to demonstrate trustworthiness is central to safety"., The pay off is a shared commitment and mutual trust.

"Cultural safety", the term raised by a Maori student at Hui Waimanawa in 1988, was translated into two documents, A Model for Negotiated and Equal Partnership and Kawa Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. These identified the expected educational outcomes for a culturally safe, graduate health professional to aspire to. These are:

* all graduates develop the skills of critical analysis

* all graduates recognise where things are wrong

* two thirds of graduates recognise the opportunities to create change and see where to intervene

* one third of graduates contribute to change

* outstanding graduates initiate change. Paua confirms NZNO, nurses and health professionals as change agents. This indeed is a time to celebrate the evolving nature of nursing's commitment to cultural safety. However, let us not become complacent in our development, but continue to examine our attitudes and realities to produce a workforce who can be defined by the people they serve as culturally safe to practise. This means not confusing cultural safety with biculturalism and learning Maori language and customs. Let us not diminish cultural safety by assuming that culture and ethnicity are one and the same. Let us remember the key concepts of cultural safety vs transcultural nursing. (See table below. (1))

Let us also not forget that there are two versions of the Treaty of Waitangi, one that reaffirms a colonial world view and one that reaffirms a Maori world view. To consider oneself culturally safe one must understand each view.

Over the following months, Paua will be presented to membership at regional council and hui. The Paua website will soon be operating. Not only will members be able to access information about Paua, they will also be enticed to visit again. Finally, let us continue to be what we do proudly, professionally and passionately.

Cultural safety                      Transcultural nursing

Indigenous cultural reality         Outsider cultural perspective

Concerned with the transfer of      Seeks to maintain power
  power and establishment of trust

Developed from experience of        Ethno nursing developed from
  colonisation                        cultural anthropology

Cultural knowledge belongs to the   Cultural knowledge can be acquired
  culture                             and managed by the nurse

Culturally safe care                Culturally congruent care

Provides care, regardful of         Sees patient as individual who may
  individual differences.             share information about
                                      difference if trust can be
                                      established

Provides care regardless of         Sees patient primarily as group
  individual differences.             member

Negotiated and equal partnership    Patient and nurse are co
  model                               participants

Interactions are bicultural         Nurses are multicultural

Culture is applied in its           Culture refers to ethnicity
  broadest sense

A requirement for New Zealand       Certificate of competence in the
  nursing and midwifery               United States
  registration

REFERENCES

(1) Ramsden, L., (2002) Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu. Wellington: Victoria University.

(2) Handy, C. (1998) The Hungry, Spirit, Auckland: Random House New Zealand Limited