Indigenous section

A document for change: Cultural safety

By James Gerrard

Interviewer | Section editor

James is a podiatry graduate who has worked in public and private settings in Victoria, New South Wales, and Tasmania, and he now lectures at La Trobe University within the discipline of podiatry. James is also a current University of Newcastle PhD candidate, involved in research that gives First Nations a voice in foot health education.

By Professor Vivienne Chuter

Interviewee | Head of discipline (podiatry) and higher degree research coordinator | College of Health, Medicine and Wellbeing | University of Newcastle.

Professor Vivienne Chuter is heavily invested in developing decolonised podiatry curricula that welcomes First Nations students, supports their podiatry studies, and produces podiatry graduates who are culturally safer and more capable of further developing cultural capabilities. The aim of such work is the pursuit of health equity in this country.

It’s time to reflect on the roles expected of all podiatrists, and in particular, the development of our cultural safety. This is highly topical since a draft document exists on this very issue, and it has recently been open for public consultation.

 

James Gerrard explains the background to this step, and he refers to industry expert, Professor Vivienne Chuter for her insights.

Each profession is drafting, or has developed, capabilities involving specific strategies. Some professions such as paramedicine, already have cultural safety strategies finalised within their professional capabilities.

What has happened

  • The National Scheme is embedding threshold professional capabilities nationally across 15 health professions - from dental and medical, to physiotherapy and nursing and midwifery professions.
  • These thresholds aim to improve our cultural safety, in line with the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025.
  • Each profession is drafting (or has developed) capabilities involving specific strategies. Some professions such as paramedicine, already have cultural safety strategies finalised within their professional capabilities.
  • We (podiatry) have just had our draft document put out for public discussion via the Podiatry Board’s ‘Draft proposed threshold professional capabilities for podiatrists’.

 

 

 

 

The draft's scope

The professional capabilities in this draft document ‘identify the knowledge, skills and professional attributes needed to safely and competently practise as a podiatrist in Australia.’

 

Also: ‘They describe the threshold or minimum level of professional capability required for registration as a podiatrist.’

 

The cultural safety aspects of the draft document relate to being a professional and ethical practitioner, as well as a communicator and collaborator.

 

 

This is bigger than us

Importantly the draft document ties cultural safety in with other professional capabilities and gives it not just equal footing, but really foregrounds cultural capability as a fundamental skill of a podiatrist.

 

This is a great example of anti-racist action by the authors and a means to work towards ending systemic racism within our profession.

 

 

What stands out 

There are a couple of points that podiatrists need to embed in our professional capabilities, such as:

 

Treat each patient with dignity and care

In the section on being a professional and ethical practitioner it says: ‘Treat each patient with dignity and care.’

 

We can do this by displaying culturally safe practice and recognising and respecting ‘Aboriginal and Torres Strait Islander Peoples' ways of knowing, being and doing.'

 

This should be done in the context of history, culture and diversity. Then we can affirm and protect these factors through ongoing learning in health practice.

 

It is an ongoing process

Ongoing learning is another important point in the document.

 

A take-home message for readers is that developing cultural safety is an ongoing process and certainly not something you get in a one-off workshop or short course.

 

Look within, and stay curious

Within the draft’s section on being a communicator and collaborator it says:  ‘Examine and reflect on one’s own culture, influences, perceptions and interactions with others from different cultures.’

 

This has four components for podiatrists:

    1. ‘Understand the impact of systemic racism and recognise the influence of one’s own cultural identity on perceptions of and interactions with Aboriginal and Torres Strait Islander Peoples and people from other cultures.’
    2. ‘Recognise how the cultural diversity of the patient’s healthcare team can influence perceptions of, and interactions with, the patient and other members of the healthcare team.’
    3. ‘Recognise different forms of cultural bias and associated stereotypes that impact on Aboriginal and Torres Strait Islander health and practice in a culturally sensitive and inclusive manner.’
    4. ‘Recognise the role of history and relationships between Aboriginal and Torres Strait Islander Peoples and white Australian society and how this has affected the inequitable distribution of privileges.’

 

These are just a few examples from the draft document that help to map a way forward for our individual and collective development of cultural safety.

We can all play an incredibly important part in the National Scheme’s cultural safety strategy by understanding the professional capability thresholds we will need to meet moving forward.

How to get involved

I encourage all registered podiatrists across all settings to look over the draft document. This work is supported by the National Scheme, the profession, as well as education, and there are explanatory notes for cultural capability domains in the draft too, including those relating to cultural safety.

 

As stated in the draft, ‘all health practitioners in Australia need a working knowledge of factors that contribute to and influence the health and wellbeing of Aboriginal and Torres Strait Islander Peoples. These factors include history, spirituality, and relationship to land, and other social determinants of health in Aboriginal and Torres Strait Islander communities.’

 

We can all play an incredibly important part in the National Scheme’s cultural safety strategy by understanding the professional capability thresholds we will need to meet moving forward.

 

 

Q&A with Professor Vivienne Chuter, Head of Discipline (Podiatry) and Higher Degree Research Coordinator at the University of Newcastle.

 

James Gerrard: What is cultural safety?

 

Prof Vivienne Chuter: If anyone is unsure what cultural safety is, have a look here at the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025.

 

Cultural safety is all about providing health care in this country that is free from racism, and that is judged to be safe to approach and use by Aboriginal and Torres Strait Islander Peoples. You will see that this strategy is inclusive of Aboriginal and Torres Strait Islander voice and leadership. You can read too that it outlines four key areas in ensuring culturally safe and respectful practice:

 

  • Acknowledging colonisation’s impact on health
  • Addressing individual racism, biases, and stereotypes
  • Recognising self-determined decision-making in healthcare and;
  • Creating and maintaining safe workplaces that support the rights and dignity of Aboriginal and Torres Strait Islander people.

 

James Gerrard: Can you take us through why culturally safe care is so essential?

 

Prof Vivienne Chuter: Providing access to culturally safe care is essential to improving health outcomes for Aboriginal and Torres Strait Islander Peoples. As podiatrists we have a central role in the health care delivery deficit and with that comes both the opportunity and responsibility to help address the cultural safety in our healthcare system. Although we have a big task ahead, developing our understanding of, and skills in culturally safe care provision should be embraced as a continual and evolving process that is consistent with our commitment to life-long learning as evidence-based health practitioners.

 

James Gerrard: Thank you for your role in contributing to the draft document and for your time here.

 

Prof Vivienne Chuter: It’s important work for us all, my pleasure.

 

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