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ADDRESSING DIVERSITY IN EVERY DAY NURSING/HE HE WHAKAARO NA TE ETITA WHAKAARO Na TE ETITA TE WHAKAEA I NGA HIAHIA O TE HUNGA KANORAU I NGA MAHI TAPUHI O IA RA.

Peoples' responses internationally regarding elections and events in the United Kingdom and United States of America have drawn attention to divisions in society. Responses indicate there is a lack of acceptance by many for ethnic, religious and gender diversity. Even though there is only limited evidence of this cultural hegemony here in Aotearoa, it is imperative that nursing and nurses in Aotearoa (and other countries) act now and embrace cultural diversity. We need to take a lead role in acknowledging diversity and in facilitating and delivering accessible and acceptable care for all.

Ethnically Aotearoa is one of the most diverse populations in the world. We also openly embrace all religions, respecting people's rights regarding beliefs. Socially, we are leaders in gender diversity with growing acceptance of marriage for gay and lesbian couples and increased recognition of the needs of intersex persons. Diversity also extends to recognising disability and acknowledging the variety of shapes the human body comes in whether the differences relate to congenital reasons, accidents or lifestyle.

The increased diversification of Aotearoa has implications for everyday nursing practice. Cultural safety (Wepa, 2015) alone will not help us work with diverse populations given the changing ways health services are delivered such as increased home-based care, electronic communication, short appointments and brief short hospital stays. We also need to utilise epidemiological (Fayram & Anderko, 2009) and transcultural (Maier-Lorentz, 2008; Miller et al., 2008) approaches. Epidemiological skills are useful for investigating patterns of everyday ways of living that contribute to health and illness behaviour. Transcultural theory will help us to understand and work with peoples' health beliefs, practices and values and address human rights. In combination, the theories and

approaches of cultural safety, epidemiology and transcultural nursing will help us gain increased understandings of the populations we work with and will be useful in the development of policies and services that are culturally responsive and that recognise others cultural ways. They will also provide a basis for nurses to have a voice.

Nurses need to use their voice to challenge the existing service arrangements and policy, make changes to how we deliver services including how we communicate with people, and create and enable innovation. For example, challenges can include campaigning for modification of health and research documentation to move from using binary coding of sex and gender to accommodate intersex and transgender peoples (Rew, Thurman, & McDonald, 2017). We need to demand that there is sufficient equipment to safely and respectfully care for people of all body sizes (Hales, de Vries, & Coombs, 2016).

Changes can be about accommodating daily routines with people, for example building in preparation and prayer time for Muslims (Mohamed, Nelson, Wood, & Moss, 2015), and establishing with people and families who should be involved in conversations regarding death and dying. Innovations we develop or get involved in can take many forms such as what we deliver (e.g., designated nurses prescribing), when (e.g., smoking cessation at primary care appointments and hospital stays), to whom (e.g., refugee services), where (e.g., marae, fairs, schools, Work & Income Offices) and how (e.g., using the internet, text).

In challenging, changing and innovating, nurses need to use an evidenced-based approach, work in partnership with people, document what we are doing and formally evaluate and publish or present the impact to provide new evidence and inform further change.

References

Fayram, E. S., & Anderko, I. (2009). Applied epidemiology for public health and community-based nurses. Journal of Continuing Education in Nursing, 40(8), 361-366. doi:10.3928/00220124-20090723-05.

Hales, C., de Vries, K., & Coombs, M. (2016). Managing social awkwardness when caring for morbidly obese patients in intensive care: A focused ethnography. International Journal of Nursing Studies, 58, 82-89. doi:10.1016/j.ijnurstu.2016.03.016.

Maier-Lorentz, M. M. (2008). Transcultural nursing: Its importance in nursing practice. Journal of Cultural Diversity, 15(1), 37-43.

Miller, J.E., Leininger, M., Leuning, C., Pacquiao, D., Andrews, M., Ludwig-Beymer, P., & Papadopoulos, I. (2008). Transcultural Nursing Society Position Statement on Human Rights. Journal of Transcultural Nursing, 19(1) 5-7. doi:10.1177/1043659607309147

Mohamed, C. R., Nelson, K., Wood, P., & Moss, C. (2015). Issues post-stroke for Muslim people in maintaining the practice of salat (prayer): A qualitative study. Collegian, 22(3), 243-249. doi:10.1016/j.colegn.2014.01.001

Pauly, B., McCall, J., Browne, A. J., Parker, J., & Mollison, A. (2015). Toward cultural safety: Nurse and patient perceptions of illicit substance use in a hospitalized setting. Advances in Nursing Science, 38(2), 121-135. doi:10.1097/ANS.0000000000000070

Rew, L., Thurman, W., & McDonald, K. (2017). A review and critique of Advances in Nursing Science articles that focus on sexual health and sexual rights: A call to leadership and policy development. Advances in Nursing Science, 40(1) 64-84. doi:10.1097/ANS.0000000000000158

Wepa, D. (Ed). (2016). Cultural safety in Aotearoa New Zealand (2nd ed.). United Kingdom: Cambridge University Press.

Nelson, K. (2017). Editorial: Addressing diversity in every day nursing. Nursing Praxis in New Zealand, 33(1), 5-6.

Kathy Nelson

Senior Lecturer, Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, NZ
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Author:Nelson, Kathy
Publication:Nursing Praxis in New Zealand
Article Type:Editorial
Geographic Code:8NEWZ
Date:Mar 1, 2017
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